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Gastroenterology > Other GI > Flashcards

Other GI Flashcards

1
Q

Prevalence of IBD and smoking protective in which one

A

100/100,000 for each, Crohn’s more common

Smoking protective in UC

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2
Q

Macroscopic features in UC and crohn’s

A

UC - rectum, colon, backwash ileitis, continous, no strictures
Crohns - mouth to anus, skip lesions, strictures

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3
Q

Microscopic UC features

A

Crypt abscesses, non-granulomatous
Shallow ulcers
Pseudopolyps

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4
Q

Microscopic Crohn’s features

A

(Tranny Granny Crohn’s skipping down rosey cobblestone lane)
Transmural
Cobblestone mucosa
Fibrosis, granulomas, fistulae

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5
Q

Systemic symptoms in IBD

A

Fever, malaise, anorexia

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6
Q

Abdo symptoms in IBD

A 
Diarrhoea 
Blood + mucous (more in UC)
Abdo pain
Tenesmus, urgency (UC)
Weight loss (crohns)
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7
Q

Abdo signs

A

Fever, tender abdo - UC

Mouth ulcers, RIF mass, perianal abscess/tags, strictures - crohn’s

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8
Q

Skin and eye features in IBD

A 
Skin 
-Clubbing 
-Erythema nodosum
-Pyoderma gangrenosum (UC)
Eyes
-Iritis, uveitis 
-Episcleritis (more in crohns)
-Conjunctivitis
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9
Q

Joint, HPB and other IBD features

A 
Joint 
-Arthritis - most common extra abdo IBD features
-Sacroilitis, ank spond
HPB 
-PSC + cholangiocarcinoma (UC)
-Gallstones (crohns)
-Fatty liver
Other 
-Amyloidosis
-Renal stones
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10
Q

Complications in UC

A

Toxic megacolon
Bleeding, venous thrombosis
Malignancy

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11
Q

Complications in Crohns

A

Fistula
Strictures/obstructions, abscess
Malabsorpion

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12
Q

Ix UC:

A

Blood, stool, imaging

Ba/gastrograffin enema - lead pipe, thumbprinting

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13
Q

Ix Crohns and diagnose

A

Blood, stool, imaging
Small bowel follow-through/enteroclysis - skip lesions, rose thorn ulcers, string kantor sign (narrow terminal ileum)
Diagnose - ileocolonoscopy + regional biopsy

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14
Q

Rx acute UC

A

NBM, IV hydrocortisone, LMWH
Then oral pred + 5-ASA
No improvement - ciclosporin, infliximab

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15
Q

Induce remission in UC

A

Oral: 5-ASA (1st line), pred (2nd line)
Topical - suppositorie/enemas of 5-ASA + steroids
Steroid sparing agents (azathioprine, mercaptopurine, not methotrexate)

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16
Q

Maintain remission in UC

A
  1. 5-ASA PO
  2. azathioprine or 6-mercaptopurine
  3. Infliximab/adalimumab
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17
Q

Acute Rx of crohns

A

IV hydrocrotisone, LMWH
Metronidazole, NBM
Then oral pred
No improvement - methotrexate + infliximab

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18
Q

Induce remission in crohns

A
  1. budesonide (ileocaecal), sulfasalazine (colitis)
  2. pred
  3. methotrexate/azathioprine/mercaptopurine
  4. infliximab
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19
Q

Maintain remission in crohns

A
  1. Azathioprine/mercaptopurine
  2. methotrexate
  3. Infliximab
20
Q

Coeliac prevalence and pathohys

A

0.5-1%
HLA-DQ2, DQ8
CD8+ mediated response to gliadin in gluten

21
Q

Presentation of coeliac

A

GLIAD
GI malabsorption
-Abdo distension/colic, steatorrhoea, renal stones, anaemia, vit D/K/B2/B6 deficiency
-Lymphoma + carcinoma (T cell lymphoma, adenocarcinoma of small bowel)
-Immune associations (IgA deficiency, T1DM, PBC)
-Anaemia (hyposplenism - target cells, Howell-Jolly bodies)
-Dermatological (dermatitis herpetiformis, aphthous ulcers)

22
Q

Antibodies in coeliac and OGD/biopsy finding

A

Anti-endomysial IgA (95% specific)
Anti TTG (transglutiminase) IgA
Anti-gliadin IgG
Biopsy - subtotal villous atrophy, crypt hyperplasia

23
Q

Rx coeliac disease

A

Gluten free diet

Dapsone - dermatitis herpetiformis

24
Q

Whipple’s disease gender and cause and biopsy finding

A

M:F 10:1
Tropheryma whippelii
PAS+ve macrophages

25
Q

Features in whipple’s disease

A 
Arthralgia 
GI - diarrhoea (malabsorption, colic)
Systemic - lymphadenopathy, cough, fever, sweats
Cardiac - endocarditis
CNS - behaviour change, ophthalmoplegia
26
Q

Rx whipples disease

A

Ceftriaxone

27
Q

Risk factors for pancreatic cancer

A 
SINED 
Smoking
Inflammation - chronic pancreatitis 
Nutrition - fatty diet 
EtOH
DM
28
Q

Pancreatic cancer presentation

A

Male >60yrs
Head - painless obstructive jaundice
Body/tail - epigastric pain
Anorexia and weight loss

29
Q

Signs of pancreatic cancer

A

Epigastric mass, splenomegaly, ascites
Painless jaundice + palpable gallbladder - Courvoiser’s law (not gallstones)
Trousseau sign - Thrombophlebitis migrans

30
Q

Ix in pancreatic cancer

A

Bloods - cholestatic LFTs, raised CA-19-9

EUS - best

31
Q

Rx pancreatic cancer

A

Whipple’s pancreatoduodenectomy

32
Q

Cause of chronic pancreatitis

A 
AGITS - 
Alcohol
Genetic (CF, HH)
Immune 
tryglycerides raised 
Structural (obstruction by tumour, pancreas divisum)
33
Q

Presentation of chronic pancreatitis

A

Epigastric pain radiate to back, better when sitting forward

Steatorrhoea, weight loss, DM

34
Q

Ix in chronic pancreatic cancer

A

raised glucose, low faecal elastase
US - psuedocyst
AXR/CT - calcification

35
Q

Complications of chronic pancreatitis

A

Pseudocyst, DM, pancreatic cancer, biliary obstruction, splenomegaly

36
Q

Hormone and location of carcinoid tumour

A

5HT (VIP, gastrin, glucagon)

Appendix 45%, ileum

37
Q

Carcinoid syndrome features

A 
FIVE HT 
Flushing
Intestinal - diarrhoea
Valve fibrosis - TR, PS
whEEze - bronchoscontriction 
Hepatic involvement - bypass 1st pass metabolism 
Tryptophan deficiency - pellagra
38
Q

Ix in carcinoid

A

Raised urine 5-HA

Raised plasma chromogranin A

39
Q

Rx carcinoid

A

Symptoms - octreotide/loperamide

Resect

40
Q

Vit A deficiency

A

Xerophthalmia
Dry conjunctivae
Night blindness–>total blindnesss

41
Q

Thiamine/B1 deficiency

A

Beriberi
Wet - Heart failure + oedema
Dry - polyneuropathy
Wernicke’s - COA

42
Q

Pellagra/nicotinic acid/B3 deificiency

A

Diarrhoea + Dermatitis + Dementia

Cause: dietary,isonizid, carcinoid syndrome

43
Q

Pyridoxine, B6 deficiency

A

Peripheral sensory neuropathy

44
Q

Vit B12/cyanocobalamin deficiency

A

Glossitis, peripheral neuropahty

Subacute combined degeneration of spinal cord - dorsal columns and corticospinal tract

45
Q

Vitamin C deficiency, scurvy

A

Gingivitis, bleeding (gums, nose, hair follicles)
muscle pain/weakness
Oedema

46
Q

Vit D deficiency - osteomalacia

A

Bone pain

Gastroenterology (7 decks)

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