PM GI Questions Flashcards
Resection of the terminal ileum puts you at increased risk of developing what condtions in the future?
Pernicious anaemia - due to vitamin B12 deficiency.
Gallstones.
Why does tenderness over McBurney’s point indicate appendicitis?
McBurney’s point represents the commonest location of the appendix from the base of the caecum.
What epithelial change occurs in Barrett’s oesophagus?
Squamous to columnar epithelium.
How does the intestinal lining change in coeliacs disease?
Flattening of villi and an increased number of lymphocytes in the lamina propria and surface epithelium. There is also gross crypt hyperplasia.
What is thiamine and where is it absorbed?
Thiamine is a water soluble vitamin and is absorbed in the jejunum.
Where is vitamin D absorbed?
Vitamin D is a fat soluble vitamin and so is absorbed in the duodenum.
Non-caseating granulomas are characteristic of what disease?
Sarcoidosis
How would you describe the pain of a duodenal ulcer?
Epigastric pain is the most common symptom of both gastric and duodenal ulcers. It is characterized by a gnawing or burning sensation and occurs after meals. Duodenal ulcer pain often awakens the patient at night.
How does a hepatic vein thrombosis present?
Ascites, liver enlargement and abdominal pain.
How does diverticulitis present?
Colicky left sided abdominal pain, associated with bloating and flatulence. Fever and leukocytosis. There may be mild iliac fossa tenderness.
How does diverticulitis present?
Colicky left sided abdominal pain, associated with bloating and flatulence. Fever and leukocytosis. There may be mild iliac fossa tenderness.
What is the general presentation of Crohn’s disease?
Feeling generally unwell and nauseous, tenderness in the right iliac fossa and the impression of fullness. THESE EPISODES HAVE HAPPENED SEVERAL TIMES BEFORE - (classic Crohn’s).
A bile pigment produced from the oxidation of heme:
Biliverdin
Sickle cell anaemia can present with what biliary hepatic condition?
Pre-hepatic jaundice.
This component contributes to the dark coloured urine brought about by gallstones obstructing the bile duct:
Conjugated bilirubin
Sodium bicarbonate and water secretion from the ductal cells of the pancreas is stimulated by what?
Secretin
Cherry red benign proliferations of blood vessels observed on the abdomen are known as what?
Campbell de Morgan spots.
Direct inguinal hernia
The abnormal protrusion of the abdominal wall originating above the inguinal ligament and medial to the epigastric vessels.
Headaches, shortness of breath and palpitation are classical symptoms of what?
Headaches, shortness of breath and palpitations are classical symptoms of anaemia. The most common nutritional causes of anaemia are B12, Folate and Iron.
Hesselbach’s triangle?
- what can occur here?
The inguinal triangle (Hesselbach’s triangle) is a region in the anterior abdominal wall. It is alternatively known as the medial inguinal fossa.
A direct inguinal hernia occurs medially to the inferior epigastric vessels (through the inguinal triangle), and an indirect hernia occurs laterally to these vessels.
Metoclopramide
Anti-emetic - commonly used to treat and prevent nausea and vomiting.
Metoclopramide
Anti-emetic - commonly used to treat and prevent nausea and vomiting.
Ileo-colic artery is a branch off what?
SMA
What does the ileo-colic artery supply?
Ascending colon and terminal ileum.
How does biliary colic present?
RUQ pain, positive murphys sign - often presents with pain after eating, particularly after high-fat meals.
How would you differentiate biliary colic vs ascending cholangitis?
In ascending cholangitis the patient may describe a similar history but would likely be more acutely unwell with a fever.
How do duodenal ulcers present?
Duodenal ulcers cause upper abdominal pain which may differ with eating, but the pain tends to be more constant, gnawing and central. If the ulcer bleeds it may also present with haematemesis or melaena.
Metoclopramide contraindications
Metoclopramide should be avoided in children and young adults due to the risk of developing oculogyric crisis.
Contraindicated in parkinsons.
Which clotting factor would be very high in acute liver failure?
In liver failure all clotting factors are low, except for factor VIII which is paradoxically supra-normal. This is because factor VIII is synthesised in endothelial cells throughout the body, unlike the other clotting factors which are synthesised purely in hepatic endothelial cells. Furthermore, whilst activated factor VIII is usually rapidly cleared from the blood stream, good hepatic function is required for this to occur, further leading to increases in circulating factor VIII.
Propanolol
Propranolol - A non-cardioselective β blocker (NSBB) is used for primary and secondary prevention of bleeding in oesophageal varices. They act by causing splanchnic vasoconstriction, reducing portal blood flow.
What makes up the femoral triangle?
SAIL
Sartorius
Adductor longus
Inguinal ligament
Roof of the femoral traingle - fascia latte
What is the clinical relevance of the femoral triangle?
Femoral nerve and its terminal branches pass through the femoral triangle - The nerve enters the femoral triangle by passing beneath the inguinal ligament, just lateral to the femoral artery. The femoral nerve also passes through here.
What is duodenal atresia?
Duodenal atresia is the congenital absence or complete closure of a portion of the lumen of the duodenum. It causes increased levels of amniotic fluid during pregnancy (polyhydramnios) and intestinal obstruction in newborn babies.
Small vs large bowel obstruction.
In small bowel obstruction, the pain tends to be colicky (cramping and intermittent) in nature, with spasms lasting a few minutes. The pain tends to be central and mid-abdominal. Vomiting may occur before constipation. In large bowel obstruction, the pain is felt lower in the abdomen and the spasms last longer.
Think bowel obstruction when?
Abdominal distension, vomiting, and absolute constipation.
A 64-year-old man has been admitted to the surgical ward for abdominal pain and bleeding per rectum. On the clerking notes it states he has not opened his bowels for five days. Today he has started vomiting and his abdomen is distended.
What is the most likely diagnosis?
Large bowel obstruction
Abdominal distension, vomiting, and absolute constipation - so think bowel obstruction.
Large bowel obstruction presents with constipation before vomiting due to the distal location in the GI tract. His age and bleeding are red flags for colon cancer, which should be investigated by colonoscopy.
Small bowel obstruction - This would cause vomiting earlier on, before constipation. Large bowel obstruction is more likely due to the longer history of constipation and the later onset of vomiting.
What are abdominal adhesions?
Abdominal adhesions are bands of scar-like tissue that form inside your abdomen. The bands form between two or more organs or between organs and the abdominal wall.
How do abdominal adhesions present?
Abdominal adhesions can kink, twist, pull, or compress the intestines and other organs in the abdomen, causing symptoms and complications, such as intestinal obstruction or blockage.
- can lead to small bowel obstruction.
What are the most common causes of large bowel obstruction?
Malignancy
Diverticular disease
Volvulus - when the intestine twists around themselves.
Hematochezia
Hematochezia is the passage of fresh blood per anus, usually in or with stools.
The ascending and descending colons are retroperitoneal.
The ascending and descending colons are retroperitoneal.
Ranitidine
Ranitidine is a competitive antagonist of the H2 receptors on gastric parietal cells
KRAS2 is mutated in almost all cases of what cancer?
KRAS2 is a genetic mutation that will be seen in almost all cases of pancreatic adenocarcinoma.
What is a tumour marker for colorectal cancer?
CEA (carcinoembryonic antigen) is not a genetic mutation but rather the most commonly used tumor marker for colorectal cancer.
Gilbert’s syndrome summary:
This patient has Gilbert’s disease where there is a deficiency in UDP glucuronosyltransferase. This enzyme conjugates bilirubin in the liver. A reduction in this results in a buildup of unconjugated bilirubin which cannot be excreted in the urine resulting in his jaundice. The symptoms become apparent during times of stress but otherwise is not clinically significant.
Wilson’s disease
Wilson disease is an inherited disorder in which excessive amounts of copper accumulate in the body, particularly in the liver, brain, and eyes. The signs and symptoms of Wilson disease usually first appear between the ages of 6 and 45, but they most often begin during the teenage years.
Gold ring in the eyes.
High alpha fetoprotein combined with chronic liver inflammation is usually a sign of what?
Hepatocellular carcinoma
Serum alpha fetoprotein is…
Tumour marker
Which type of hernia becomes apparent on a cough?
Direct inguinal hernia.
H.pylori is gram what + anerobe / aerobe?
Gram negative, oxidase positive, comma-shaped rods aerobe.
What is the treatment for H.pylori infections?
The standard treatment is triple therapy with two antibiotics and one proton-pump inhibitor. Amoxicillin and clarithromycin can be used as the antibiotics, with metronidazole if the patient is allergic to amoxicillin.
The pancreas forms from ventral and dorsal outgrowths of where?
Duodenum
Intussusception
Intussusception is a condition in which one segment of intestine “telescopes” inside of another, causing an intestinal obstruction (blockage).
Can present in young children with red current jelly stools. Child often draws there knees up to their chest.
Pyloric stenosis is associated with projectile vomiting.
Pyloric stenosis is associated with projectile vomiting.
Meckel’s diverticulum
Meckel’s diverticulum is an outpouching or bulge in the lower part of the small intestine. The bulge is congenital (present at birth) and is a leftover of the umbilical cord.
It is useful to remember the rule of 2s. Meckel diverticulum occurs in 2% of the population, 2% are symptomatic, children are usually less than 2 years, affects males twice as often as females, is located 2 feet proximal to the ileocecal valve, is 2 inches long or less, and can have 2 types of the mucosal lining.
How does Meckel’s diverticulum present?
Gastrointestinal bleeding (which can be seen in the stool). Abdominal pain and cramping. Tenderness near the navel (belly button). Obstruction of the bowels, a blockage that keeps the contents of the intestines from passing.
What two structures come together to form the ampulla of Vater?
Common bile duct and pancreatic duct.
Coeliacs disease is sometimes accompanied by what rash?
Sometimes coeliac disease is associated with a vesicular rash, known as dermatitis herpetiformis.
- Dermatitis herpetiformis (DH) is a rare, chronic, autoimmune skin condition characterized by the presence of groups of severely itchy blisters and raised red skin lesions. These are most commonly located on the elbows, knees, buttocks, lower back and scalp.
Cells with hyperchromatic nuclei forming irregular gland-like structures is suggestive of what?
Adenocarcinoma / Adenoma
Transmural inflammation with granulomas and lymphoid aggregates is associated with Crohn’s.
Transmural inflammation with granulomas and lymphoid aggregates is associated with Crohn’s.
How does Omeprazole work?
Omeprazole is a proton pump inhibitor which inhibits H+/K+-ATPase, which is found in parietal cells.
Ranitidine
H2 receptor antagonist - prevents the action of histamine.
What is diphenoxylate and what does it do?
Antidiarrhoeal medication - Diphenoxylate acts on μ-opioid receptors in the GI tract to slow down peristalsis.
