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more GI Flashcards

1
Q

first line of moderate exacerbation of UC

A

aminosalicyclate eg mesalazine or sulfasalazine

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2
Q

– are second line to mild to moderate exacerbation of UC

A

steriods eg prednisolone

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3
Q

treatment for acute/ severe exacerbation of crohns/ UC for those not responding to steriods

A

infliximab

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4
Q

patient with UC, suffering severe abdomen pain and fever after taking anti-diarrhoeals, should consider

A

toxic megacolon and this should be X-ray of the abdomen

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5
Q

patient from India, abdominal complaints that did not respond to antibiotics, now got weightloss and anorexia,

A

intestinal tb

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6
Q

what test for intestinal tb

A

ileal biopsy

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7
Q

raised anti-tissue transglutaminase antibody is associated with

A

Coeliac disease

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8
Q

– is a disease of the small intestine caused by gluten sensitivity

A

coeliac disease

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9
Q

villous atrophy

A

coeliac disease

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10
Q

anti-thyroid stimulating hormone receptor antibodies

A

graves disease

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11
Q

type 1 diabetes results in destruction of

A

islet cells

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12
Q

patient with end stage liver disease presents with painful abdomen, ascites, fever what should you do

A

ascitic tap- investigation

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13
Q

investigation of choice for coeliac disease

A

anti- TTG

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14
Q

classic presentation of primary biliay cholangitis

A

increasing jaundice, pruritus (itchy skin), arthralgia (pain in a joint). hepatomegaly, clubbing, xanthelasmata (yellow collection on skin typically around eyelid), hyperpigmentation(patches of skin become darker)

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15
Q

appropriate investigation for primary biliary cholangitis

A

anti-mitochondrial antibodies

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16
Q

21y/o with 2 week of jaundice, preceded by anorexia, athralgia, fever and a tender, enlarged liver

A

acute hepatitis

investigation for this Hep A immunoglobulin M (IgM)

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17
Q

most common cause of acute hepatitis

A

Hep A

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18
Q

Haemochromatosis presents with

A

iron overload: jaundice, hepatomegaly, arthritis, hyperpigmentation, infertility, small testes

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19
Q

investigation for heamochromatosis

A

high ferritin or iron levels

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20
Q

associated with human leukocyte antigen A3

A

haemochromatosis

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21
Q

ascending cholangitis triad

A

pyrexia/rigours, jaundice, RUQ abdo pain

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22
Q

investigatio for ascending cholangitis

A

ERCP

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23
Q

increasing jaundice, breathless on exercise and recurrent lung infections,show obstructive pattern

A

alpha 1 antitryptysin

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24
Q

kayser fleischer rings ( greenish-brownish rings due to copper depostition in the cornea of the eye)

A

Wilsons disease

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25
Q

children and young people, with hepatic problems and neurological symotoms such as dysarthria (speech disorder), tremor, involuntary movements

A

wilsons disease

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26
Q

treatment for wilsons disease

A

penicillamine

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27
Q

PBC typically presents

A

middle aged females, itching ,jaundice and sjogrens syndrome

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28
Q

bronzing of the skin

A

haemochromatosis

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29
Q

hereditary non-polyposis colorectal cancer syndrome has what approx liftetime risk for developing colorectal cancer

A

50-70%

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30
Q

patients presents with acute cholangitis and has raised CRP, what next

A

prompt IV antibiotics

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31
Q

suitable choice of antibiotics for acute cholangitis

A

piperacillin and tazobactam

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32
Q

fever, heart mumur, arthritis

A

infective endocarditis

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33
Q

infective endocarditis iv drug users

A

staph aureus

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34
Q

infective endocarditis with prosthetic heart valves or central venous access lines- surgery?

A

staph epidermis

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35
Q

treatment of suspected infective endocarditis w no prosthetic heart valves

A

amoxicillin and gentamicin

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36
Q

what can put you at increased risk of hepatotoxicity following paracetemol overdose

A

anorexia

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37
Q

– commonly seen in alcohol withdrawl due to malnutrition. Need to be careful of re-feeding syndrome. alcohol can cause a metabolic acidosis

A

hypophosphataemia

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38
Q

seizures in alcohol withdrawl are

A

common

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39
Q

intermittent dysphagia, more diffult swallowing liquids than solids

A

neuromuscular conditions- (result in abnormal peristalsis of the oesophagus)- oesophageal dysmotility.

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40
Q

-progressive dysphagia for liquids more than solids, severe episodes of chest pain accompanying dyspahgia, barium swallow shows birds peak, mamoetry reveal abnormally high lower oesophageal sphincter tone that fails to relax on swallowing

A

achalasia

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41
Q

sensation of food getting stuck

A

GORD

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42
Q

22y/o studying hard for exams, intermittent abdo apin and bloating, change in bowel habit and going to loo helps to relieve her abdominal pain

A

Irritable bowel syndrome -

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43
Q

diagnosis of irritable bowel syndrome

A

recurrent abdo pain or discomfort at least 1 day per week in the last 3 months with 2 or more of the following:

  • improvement with defecation
  • onset associated with change in frequency of stool
  • onset associated with change in form (appearance) of stool
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44
Q

treatment for colicky abdo pain with irritable bowel syndrome

A

Mebeverine

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45
Q

widened mediastium

A

achalasia

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46
Q

best investigation for suspected achalasia is

A

oesophageal manometry study

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47
Q

most people with diverticulitis remain

A

asymptomatic

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48
Q

25% of people with this get symtpoms such as Left lower quadrant pain, worsened by eating and relieved after bowel emptying

A

diverticulitis

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49
Q

evidence of diverticular inflammation suggested by

A

tachycardia and fever

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50
Q

prolonged laxtive use or abuse can cause

A

melanosis coli

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51
Q

macrophages containing lipofuscin in the mucosa -toad back appearance

A

melanosis coli

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52
Q

crypt abscesses

A

UC

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53
Q

non caseating granuloma in the mucosa,cobblestone

A

crohns disease

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54
Q

crohns -

uc-

A
  • diarrhoea( usually without blood, but not uncommonly with), abdo pain, general malaise and weight loss

bloody diarrhoea, abdo pain , malaise and weight loss

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55
Q

vitamin B – in chronic alcohol users

A

1

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56
Q

all patients with altered mental status or nutritional deficiency should have

A

thiamine repletion

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57
Q

encephalopathy (altered mental state), oculomotor dysfunction (eye coordination) , gait ataxia (abnormal uncoordinated movements)

A

wernicke’s encephaolpathy - alcoholics

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58
Q

prolonged vitamin b12 defiency causes

A

macrolytic anaemia

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59
Q

epigastric pain radiating to back, nausea and vomitting, post hepatic jaundice( indicated by severely raised ALP, mildly raised AST and raised bilirubin)

A

pancreatitis

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60
Q

if been vomitting since morning,

A

NG tube can be used for air and fluid removaland used to put liquid food into the stomach

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61
Q

treatment for pancreatitis

A

Admission, IV fluids, anagesia, nil by mouth, NG tube

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62
Q

expect –hepatic jaundice fromm malaria

A

pre

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63
Q

raised bilirubin, low haemoglobin, ALT and ALP are normal

A

Pre hepatic jaundice

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64
Q

young perosn drank too much alcohol and being vomitting alot. now vomitting blood

A

mallory -weiss tear- longitudinal mucosal laceration at the gastro-oesophageal junction or cardia as a result of repeated retching. if bp, pulse, Hb normal then can be discharged home next morning

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65
Q

most common cause of nodular hepatomegaly

A

liver metastases

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66
Q

Alt would be elevated

A

Cirrhosis

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67
Q

severe flare up of UC

A

Corticosteriods added to oral mesalazine

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68
Q

moderate exacerbation of uc treatment

A

add topical aminosalicylate to oral mesalazine

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69
Q

most common carcinoma of anal tract

A

squamous cell carcinoma -associated with HPV infection - transmitted by anal intercourse

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70
Q

ampullary carcinoma

A

v rare

  • abdo pain, distended and palpable gall bladder
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71
Q

plummer vinson syndrome is associated with squamous cell carcinomas of upper GI tract especially the pharynx and oesophagus

A
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72
Q

features of plummer vinson syndrome

A

oesophageal webs, dysphagia, iron deficiency anaemia, glossitis

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73
Q

what intestinal disease requires bloof tests and small intestinal biopsy for acurate diagnosis

A

Coeliac disease

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74
Q

foamy macrophages containin gnumerous acid fst bacilli

A

myobacterium avium infection

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75
Q

had abdo surgery and now presents with malabsorption, low vitamin b12, high serum folate

A

Small intestinal bacterial overgrowth (SIBO)

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76
Q

gold investigation for SIBO

A

culture of small intestinal fluid aspirate

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77
Q

cope’s sign

A

pain of apeendicitis is stimulated by the flexion and internal rotation of the hip

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78
Q

pembertons sign

A

elicted when a patient with superior vena cava obstruction raises the hands above their head

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79
Q

murphys sign

A

inspiration during palpitation of the right upper quadrant elicits pain if the gallbladder is inflamed

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80
Q

Psoas sign

A

test for appendicitis

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81
Q

rovsing sign

A

another test for appendicitis, palpitation in the left iliac fossa reproduces pain in the right iliac fossa

82
Q

MRI appropriate for

A

pelvic floor dysfunctions

  • feeling of incomplete defaecation
  • straining
83
Q

weight loss and painless jaundice, repeated admissions of pancreatitis

A

pancreatic cancer

84
Q

risk factors for pancreatic cancer

A

chronic pancreatitis, alcohol, smoking, diabetes,

85
Q

the patient has dyspepsia ( epigastric pain during and after eating), most likely due to peptic ulcer disease (—-)

A

as it wakes her up at night

86
Q

one of the causes of peptic ulcer disease is primary hyperparathyroidism which results in excess gastric acid secretion by inducing

A

hypercalcaemia (elevated serum calcium)

87
Q

redcurrant jelly in nappy

A

meckels diverticulum suspected

88
Q

in meckels diverticulum,

A

two or more types of tissue can be present

89
Q

rectal involvement is associated with

A

UC

90
Q

transmural inflammation, fistulae and —are typical of crohns

A

abscesses

91
Q

— affects only the mucosa and submucosa so is less prone to forming fistuale and abscesses

A

UC

92
Q

most important medication for variceal bleeds is

A

terlipressin

93
Q

severe epugastri pain and vomitting bright red blood, cool extremities, asicitc abdo, spider naevi on neck

A

oesophageal variceal blled

94
Q

if suspect inflammatory bowel disease what investigation is essential

A

Plain abdominal film - to exclude dilatation of the colon. crohns may exhibit small bowel dilatation of abdo xray

95
Q

not do – if moderate to sever inflammatory bowel disease as there is a high risk for perforation and this would be considered after resolution of the flare

A

colonscopy

96
Q

recommended that all patients presenting with diarrhoea undergo

A

rigid sigmoidoscopy

  • however perform abdo film/xray before this invasive invesigation
97
Q

why is urseodeoxycholic acid given to patients with PBC, when treatment of choice is liver transplant

A

reduces the rate of liver failure in paitents with PBC

98
Q

patient has NGT tube inserted and and what precaution before starting enetral feeding

A

Chest radiograph - confirm NGT placement

99
Q

How should NGT tube be placed

A

down the midline,past the carina (bifurcation of the trachea), past the level of the diaphragm, deviates to the left with the tip seen in the stomach

100
Q

2 jobs of ngt

A

enteral feeding/ medication administation

decompression of the stomach

101
Q

what hormone inhibits gastrin secretion

A

somatostatin

102
Q

– and – aggrevates irritable bowel syndrome

A

caffeinated and fizzy drinks

103
Q

PBC- lethargy, weakness and increasing itch -alkaline phosphatase raised

autoimmune hepatitis-

PSC- ASMA and ANCA may be positive- diagnosis MRCP or ERCP - beaded appearance

A

fever, rash, malaise, arthrirtis

104
Q

can develop peptic ulcers secondary to

A

corticosteriod and naproxen use

105
Q

peptic ulceration usually due to

A

h.pylor(gram negative)

NSAIDs

106
Q

patient with peptic ulcer disease tends to present with

A

dyspepsia

107
Q

what test is used in the diagnosis of helicobacter infection

A

rapid urease test

108
Q

h.pylor produces the enzyme — that converts urea to ammonia and carbon dioxide

A

urease

109
Q

extra intestinal features of Inflammatory Bowel disease

A

athralgia (joint pain without inflammation), arthritis(without inflammation), Polyarthritis, sacroiliitis

110
Q

severe epigastric pain that radiates to back

A

acute pancreatitis

111
Q

amylase raises after onset of — and returns to normal in approx 5 days

A

acute pancreatitis

in severe alochols this is not the case

112
Q

palpable gall bladder, RUQ itch,

A

cholangiocarcinoma

113
Q

features of cholangiocarcinoma

A

raised CA 19-9 and CEA, normal AFP

114
Q

middle aged women, intense itching and fatigue

A

Primary biliary cholangitis

115
Q

dilated oesophagus

A

achalasia

116
Q

achalasia: disorder of motility caused by failure of the

A

oesophageal sphincter to relax

117
Q

what can be used to relax the sphincter in achalasia

A

calcium channel blockers and nitrates

118
Q

unstable observations , a tender abdomen with history of ulcerative colitis is concerning for

A

toxic megacolon

  • abdo x ray should be ordered to assess for this- transverse colon will typically be dilated >6cm which is diagnostic of TM
119
Q

what criteria is used for morphological classification of intestinal biopsy in coeliac disease

A

Marsh criteria

120
Q

crypt abscesses are typical for

A

ulcerative colitis

121
Q

stricturing of bowel wall and fistula formation is in UC or crohns

A

crohns

122
Q

is the risk of malignancy significantly lower in. crohns disease or UC

A

crohns disease

123
Q

student binge drinks every weekend for past year and now vomitting has a bit of blood

A

Barrets oesophagus

  • short history of alcohol excess so unlikely to present with varices or ulcers
  • can give PPI
124
Q

24hrs of vomitting and now has blood

A

mallory-weiss syndrome - tear in the mucosa as a result fo prolonged vomiting episode

125
Q

diclofenac and other non-steriodal anti-inflammatory medications increase the risk of – by inhibiting the production of prostaglandins

A

peptic ulceration

126
Q

epigastric pain afetr meals , black tarry stools, coffe ground vomitting

A

upper GI heamorrhage secondary to bleeding peptic ulcer

127
Q

long history of excess alcohol, massive haematemesis, jaundice, hypotensive and tachycardic

A

oesophageal varices

128
Q

most common cuase of oesophageal or gastric varices is

A

alcohol

129
Q

intermittent haemoptysis, small amounts of haematemesis, telangiectasia(dilated or broken blood vessels) on face

A

Osler-weber -rendu syndrome

130
Q

in IV drugs users there is a high incidence of

A

Human immunodeficiency virus(HIV), hepatitis viruses or tb

131
Q

cryptospordium is an infection that can be acquired by immunocomprised ie drug users and thos who have had tb

A

profuse watery diarrhoea, abdo cramps, fever

132
Q

student w 12 hours of vomitting, abdo pain, watery diarrhoea

A

food poisoning

133
Q

most common cause of diarrhoea in young people

A

food poisioning or acute gastroenteritis

134
Q

diagnosis of UC

A

endoscopic biopsies

135
Q

Almost always a consequence of chronic alcohol misuse. steatorrhoea( pale, foul-smelling stool that is hard to flush away). abdo pain, diarrhoea

A

Chronic pancreatitis

  • not always present with epigastric pain that radiates to back and relieved on sitting forward and worse on eating
136
Q

change in bowel habit and blood in the stool should immediately be referred for 2 week pathway of suspicion of

A

colorectal carcinoma

137
Q

12 cm dilatation of the transverse colon and has UC

A

Toxic megacolon

138
Q

medications for toxic megacolon

A

IV corticosteriod (hydrocortisone), LMWH ( as high risk of venous thromboembolism) , fluids, reassess after 72 hrs

139
Q

Iv infliximab is secodn line for severe active – in patients who fail to respond to IV steriod treatment.

A

UC

140
Q

– is characterised by tachycardia, fever, hypotension, dilatation usually of the transverse colon greater tham 6cm

A

toxic megacolon

141
Q

most specific antibody for autoimmune hepatitis

A

anti-smooth muslce antibodies

142
Q

antibody associated with primary biliary cholangitis

A

anti-mitochondrial antibodies

143
Q

test that h. pylori has been eradicated following treatment

A

13C urea breath test

144
Q

red flag symptoms suggesting organic cause of abdo pain rather than irritable bowel sydnrome

A

unintentional weight loss, rectal bleeding, family history of bowel or ovarian cancer, older than 60 with a change in bowel habit

145
Q

plummer vinson syndrome is a disease characterised by

A

dysphagia, iron deficiency anaemia, glossitis

146
Q

what is it that causes dysphagia in plummer vinson sydrome

A

oesophageal web

147
Q

treatment of plummer-vinson syndrome

A

iron supplements

148
Q

dysphagia to both solids and liquids, PPI therapy failing and upper endoscopy normal. CXR normal. ECG normal. what investigation

A

oesophageal manometry

-consistent with achalasia

149
Q

what is barium swallow helpful for

A

obstruction, evidence of reflux, or strictures in the oesophagus

150
Q

associations of gastric cancer

A

pernicious anaemia, blood group A, smoking diet, H.pylori

151
Q

H. pylori is not a risk for —cancer

A

Gastric cardia

152
Q

hep B is more common in what countries

A

sub-saharan africa and east asia

153
Q

hep c is more common in what countries

A

african countries such as egypt, easter european adn latin america

154
Q

Liver cirrhosis causes:

A

DR- DRUGS- AMIODARONE, METHYLDOPA, METHOTREXATE

H-HEPATITIS - B AND C

E- ENZYME DEFICIENCY- alpha 1 antitrypsin deficiency

P-primary biliary cirrhosis/ primary sclerosing cholangitis

A- alcohol abuse -chronic

T- tyrosinosis
I-indian childhood

Cryptogenic/CF/ copper deposition; wilsons disease/ haemoChromatosis
Autoimmune hepatitis

DR HEPATICA

155
Q

how does haemochromatosis present

A

cirrhosis, hyperpigmentation, arthritis, diabetes

156
Q

inflammatory infiltrates with plasma cells, lymphocytes and eosinophils in the lamina propria and thick subepithelial collagen band

A

collagenosu colitis

treatment- anti-diarrhoeal- Loperamide

157
Q

period acid -schiff (PAS) positive macrophages

A

whipples disease

-treatment- ceftriaxone or penicillin V

158
Q

motile spiral shaped bacteria

A

campylobacter, most common cause of acute diarrhoea in UK - usually from poultry or dairy products

159
Q

treatment of severe acute diarrhoea of campylobacter

A

erthyromycin

(ciprofloxacin or azithromycin as alternatives)

  • if not severe then rehydrate
160
Q

most common mode of transmission of Hep C

A

exposure of infected blood

161
Q

hep c is what kind of virus

A

RNA

162
Q

diarrhoea, facial flushing, bronchospasm

A

carcinoid syndrome - raised 5 -HIAA is suggestive

163
Q

important medication for variceal bleed is

A

terlipressin

164
Q

haematemesis of bright red blood, alcoholic, cool extremities, guardin gover the epigastric rehion, ascitic, spider naevi on chest and neck

A

variceal bleed

165
Q

follwing terlopressin for variceal bleed what is next

A

band ligation and if this does not control the bleed, intra-hepatic portosystemic shunt (TIPS)

166
Q

50% of those with hep B develop

A

jaundice

167
Q

most people 65-75% of hep c are

A

assymptomatic

168
Q

when –is greater than 1000, the most likeley cause is hepatitis

A

ALT

169
Q

hep — =ASIA

A

B

170
Q

thickened small bowel folds on barium swallow

A

tropical sprue

171
Q

Giardia lamblia is a flagellated

A

protozoan - contaiminaetd water or poor cooking -street stalls

172
Q

diagnosis of trpoical sprue

A

indentifying cysts or trophozoites in stool sample

173
Q

treatment for giardiasis

A

rehydration and oral metronidazole

174
Q

been travelling and diarrhoea more than a week

A

giardiasis

175
Q

symtoms improves if eats fewer dairy products

A

lactose intolerance

176
Q

used to decrease diarrhoea in chronic pancreartitis/CF

A

pancreatin

177
Q

anti diarrhoeal used in acute

A

loperamide

178
Q

anti-diarrhoeals used in chrons, PBC, pruritus, hypercholestolaemia

A

colestyramine

179
Q

oesophagus hiatus at what level

A

T10

180
Q

inferioru vena cava at diaphgram

A

T8

181
Q

aorta at diaphragm

A

T12

182
Q

T12

A

aorta, azygous vein, thoracic duct

183
Q

what is commonly graded on the LA classification

A

oesophagitis

184
Q

colon malignancy is staged by

A

dukes staging system /TNM

185
Q

cirrhosis of the liver staging system

A

Child-pugh

186
Q

peptic ulcers classification system is

A

johnson

187
Q

glossitis (beefy red tongue)

A

vitamin b12 deficiency

188
Q

vitamin b12 is found in

A

meat, fish and dairy products

  • absorbed in the terminal ileum
  • strict vegans likely to present with this
189
Q

antibody present in some crohn’s patietns

A

saccharomyces cerevisiae

190
Q

pANCA is associated with

A

UC

191
Q

triad for pellagra

A

diarrhoea, dermatitis (could be rash on hand), dimentia

192
Q

pellagra is

A

niacin (vitamin b3) deficiency

193
Q

scurvy can present with red dots on the skin but also with

A

bleeding gums adn joint pain

194
Q

SLE presents with

A

painful swollen joints and red butterfly rash over the face

fevers and mouth ulcers are also common

195
Q

abdo pain that raidates to back or worse lying down

A

pancreatitis

196
Q

bruising around umbillicus is classical of

A

retroperitoneal haemorrhaeg(cullens sign)

197
Q

if coeliac trunk is obstructed this will affect the stomach…

A

duodenum, gallbladder, pancreas, spleen, liver , abdominal portion of the oesophagus

198
Q

jejunum and ileum are supplied by

A

superior mesenteric arteries

199
Q

what supplies the transverse colon

A

proximal 2/3rds = right and middle colic arteries

distal 1/3=left colic artery

200
Q

what supplies the descending colon

A

left colic artery

201
Q
A

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