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Sheff 3b > Passmed GI / liver > Flashcards

Passmed GI / liver Flashcards

1
Q

An 18-year-old female presents with tremor and dysarthria. There is a family history of early onset liver disease…

Dx?

A

Wilsons

Onet 10-25
Liver + Neurological problems may manifest as dementia, tremor or dyskinesias.

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2
Q

Triad in Plummer-Vinson syndrome?

Mx?

A

dysphagia (secondary to oesophageal webs)
glossitis
iron-deficiency anaemia

iron supplementation and dilation of the webs

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3
Q

If severe vomiting -> oesophageal rupture…called what?

A

Boerhaave syndrome

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4
Q

What is melanosis coli? seen in?

A

Melanosis coli is a disorder of pigmentation of the bowel wall. Histology demonstrates pigment-laden macrophages

It is associated with laxative abuse

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5
Q

Amsterdam criteria for HNPCC

A

at least 3 family members with colon cancer

the cases span at least two generations

at least one case diagnosed before the age of 50 years

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6
Q

Small bowel bacterial overgrowth syndrome Rfs

A

neonates with congenital gastrointestinal abnormalities
scleroderma
diabetes mellitus

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7
Q

Small bowel bacterial overgrowth syndrome features

A

chronic diarrhoea
bloating, flatulence
abdominal pain

[Similar to IBS]

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8
Q

Small bowel bacterial overgrowth syndrome Dx / Mx

A

Hydrogen breath test

Mx underlying disorder
Co-amoxiclav or metronidazole or rifaximin

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9
Q

Peutz-Jeghers syndrome features

A

hamartomatous polyps in GI tract (mainly small bowel)

pigmented lesions on lips, oral mucosa, face, palms and soles

intestinal obstruction e.g. intussusception

gastrointestinal bleeding

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10
Q

Where is most likely to be affected by ischemic colitis

A

splenic flexure

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11
Q

Usual cause of acute mesenteric ischemia?
Common precipitating factor?
Mx?

A

Embolism
AF

Urgent surgery

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12
Q

Why does ischemic colitis usually occur at splenic flexure?

A

‘watershed’ area supplied by both areas

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13
Q

Seen on Xray of ischaemic colitis ?

A

thumbprinting’ may be seen on abdominal x-ray due to mucosal oedema/haemorrhage

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14
Q

Mx ischemic colitis

A

usually supportive

- surgery may be required

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15
Q

Why do you get pneumococcal vaccine in coeliac?

A

hyposplenism

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16
Q

Why do you avoid metoclopramide in obstruction

A

is a pro-kinetic anti-emetic so could cause a perforation

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17
Q

Carcinoid syndrom effect on heart

A

Right side compression -> tricuspid insufficiency and pulmonary stenosis

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18
Q

Coeliac
-> Weight loss, abdo distension, fevers, night sweats, diarrhoea
+lymphadenopathy

A

enteropathy-associated T cell lymphoma

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19
Q

Bar NSAIDS what other class of drug cause PUD

A

SSRIs

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20
Q

Zollinger-ellison often occur due to what syndrome? Other parts of it?

A

multiple endocrine neoplasia type I (MEN-I)

parathyroid (95%): hyperparathyroidism due to parathyroid hyperplasia
pituitary (70%)
pancreas (50%

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21
Q

What happens in Zollinger-Ellison syndrome? Name 2 features?

A

excessive levels of gastrin, usually from a gastrin secreting tumour

multiple gastroduodenal ulcers
diarrhoea
malabsorption

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22
Q

2 scoring systems for acute upper GI bleed

A

Blatchford score at first assessment,

Rockall score after endoscopy

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23
Q

Seen on histology of gastric ca

A

signet ring cells

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24
Q

A 29-year-old man who is known to have ulcerative colitis is admitted to hospital with a flare of his disease. For the past three days he has been passing up to five bloody stools per day. Over the past 24 hours he has also developed abdominal pain and a low grade pyrexia
What might this be and whats the Ix

A

toxic megacolon

AXR

25
Q

Dermatitis, diarrhoea, dementia/delusions, leading to death…?

A

Pellagra - vit B3 deficiency

26
Q

HBsAg

anti-HBc

anti-HBs

A

HBsAg = ongoing infection, either acute or chronic if present > 6 months

anti-HBc = caught, i.e. negative if immunized

Anti-HBs implies immunity (either exposure or immunisation). It is negative in chronic disease

27
Q

Main risk of clindamycin mx

A

Clostridium difficile

28
Q

Mx c diff

A

metronidazole
+isolate for 48hrs
[vanc after]

29
Q

What do you give when draining large volume ascites? why?

A

Albumin

-reduce risk of paracentesis-induced circulatory dysfunction

30
Q

3 drugs causing pancreatitis

A

steroids
valproate
mesalazine, azathioprine

31
Q

Big Upper GI bleed blood Ix

A

Raised Urea

32
Q

What drug pre endoscopy for varicies

A

terlipressin

33
Q

What is this?
A 50-year-old male with a long history of cirrhosis secondary to chronic hepatitis C is brought to the emergency department by his partner with a 2-day history of increasing confusion.

He is drowsy but is rousable to voice. He is able to obey commands but is not oriented to where he is. Further examination revealed significant hepatic flap, multiple spider naevi on the torso, and mild abdominal distension with shifting dullness.

He is afebrile and his partner denies any history of recent infection.

Mx?

A

hepatic encephalopahty

Lactulose -> stop ammonia absorption
[+rifaximin]

34
Q

mx of hepatorenal

A

terlipressin

albumin for volume expansion

TIPS

35
Q

bar colon most common Ca in HNPCC

A

Endometrial

36
Q

NAFLD - found incidentally on US…. What Ix should you do

A

enhanced liver fibrosis (ELF) blood test to check for advanced fibrosis

37
Q

Key ix screen current infection with HBV

A

HBsAg

38
Q

A 57-year-old woman with a history of gallstones presents with progressive right upper quadrant pain, rigors and jaundice.

Dx

A

Ascending cholangitis

39
Q

A 62-year-old presents with upper abdominal pain. She has recently been discharged from hospital where she underwent an ERCP to investigate cholestatic liver function tests. The pain is severe. On examination she is apyrexial and has a pulse of 96 / min.

Dx

A

Acute pancreatitis

40
Q

A 76-year-old woman presents with abdominal pain, distension and vomiting. She recently had an episode of acute cholecystitis and is awaiting a cholecystectomy. She feels her symptoms have returned over the past few days. On examination her abdomen is distended.

Dx

A

Gallstone ileus

41
Q

Dx of wilsons

A

Reduced serum caeruloplasmin / copper

increased 24hr urinary copper excretion

42
Q

vessles in TIPS

A

Hepatic vein
Portal vein

[MAD TING - no jugular)

43
Q

What electrolyte change indicates risk of refeeding syndrome

A

hypophosphate

44
Q

LFTs are not often best way of looking at liver health - what is?

A

PT

Albumin

45
Q

Best ix for cirrhosis

A

fibroscan (Transient elastography)

46
Q

what is gilberts syndrome

A

high bilrubin in blood

47
Q

What else do you screen for with diagnosis of AI thyroid / T1DM?

A

Coeliac

48
Q

Why is crohns associated with gallstones

A

can result in terminal ileitis, this is the section of the bowel where bile salts are reabsorbed. When this area is inflamed and the bile salts are not absorbed and people are prone to development of gallstones.

49
Q

What is tenesmus

A

need to keep emptying bowels

50
Q

deranged LFTs combined with secondary amenorrhoea in a young female

A

AI hepatitis

51
Q

Best screen for harmful alcohol drinking and alcohol dependence?

A

AUDIT questionnaire

52
Q

On examination, she was found to have a painful palpable umbilical node. This metastatic nodule representing advanced malignancy is eponymously referred to as?

A

sister mary joseph’s node

53
Q

Key finding that indicates cirrhosis has occurred in chronic liver disease

A

Low platelets

54
Q

A 35-year-old lady presents to the emergency department with right upper quadrant pain. She has also noticed that her skin seems slightly yellower over the last week or so and you notice a yellow tinge to her sclera. On further questioning, she complains of itching of her arms. Her only past medical history of note includes ulcerative colitis for which she takes mesalazine.

Given her presentation, what is the best investigation to diagnose the most likely underlying condition?

Key Ix?

A

ERCP - investigation of choice in primary sclerosing cholangitis

55
Q

Key comp of PSC

A

Cholangiocarcinoma

56
Q

A 66-year-old gentleman with hypertension, gout, type 2 diabetes, and atrial fibrillation presents to the emergency department with a 12-hour history of bloody diarrhoea and abdominal pain, which he describes as “the worst pain he’s ever had” and rates as 10/10. He has no recent travel history, and his contacts are well.

On examination, he is apyrexial and has a blood pressure of 126/82 mmHg. His abdomen is soft, non-tender, and there are normal bowel sounds. Digital rectal examination reveals blood mixed with the diarrhoea but is otherwise normal

Ix for Dx ?

A

Serum lactate

Acute mesenteric ischaemia causes a raised lactate

57
Q

Always examin what in right iliac fossa pain

A

scrotum

58
Q

PBC LFTs? Antibody?

A

rise in ALP and γGT

Anti Mitochondrial antibodies

Sheff 3b (33 decks)

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