points to learn Flashcards
1
Q
what does GORD usually present with
A
hiatus hernia
2
Q
what is the GS for hernia
A
BS
3
Q
what is achalasia
A
abnormal relaxation of LOS
4
Q
what is oesophageal carcinoma associated with
A
plummer vinson syndrome
5
Q
what are oesopahgeal varices caused by
A
portal hypertension causes dilated collateral veins at the site of portosystemic anatomoses
6
Q
what is the most common cause for portal hypertension
A
cirrhosis
7
Q
what is the treatmetn for oesophageal varices
A
- resus, antibiotics, terlipressin, early OGD + EVL
- bleed stops = propranolol and banding
- bleed continues = EVL or SB tube
- bleed continues = TIPSS
8
Q
what is a gastric lymphoma
A
derived from MALT and associated with B cell lymphomea
9
Q
what are the symptoms of gastruc lymphoma
A
stomach pain, ulcers, >60, hpylori
10
Q
what does GIST look like on histology
A
spindle cells
11
Q
most common cause of PUD
A
h pylori
12
Q
h pylori tests
A
urease breath test, faecal antigen test, serology IgG
13
Q
GS for gastroparesis
A
oesophageal manometry
14
Q
intestial failiure 1 causes
A
obstructin, surgical resection, congenital, malabsorption
15
Q
intestinal failure 2 causes
A
sepsis, abdo surgery, coeliac, crohns, malignancy,short bowel syndrome
16
Q
presentation of intestinal failure 2
A
abdo fistulae
17
Q
causes of intestinal failure 3
A
short bowel syndrome
18
Q
symptoms ofIBS
A
bloating, urgency, tenesmus, mucus, worrsening after food
19
Q
tests for IBS
A
lower GI endoscopy if <50
20
Q
treatment for IBS
A
stop opiates and analgesia loperamide laxaiev mebervine - anti spasmodic amitryptiline - anti depressant
21
Q
genes for coeliac disease
A
HLA DQ2 and DQ8
22
Q
causes of coeliac
A
childhood diabetes, herpetitis formis
23
Q
what happens if coeliac patients stops responding to gluten free diet
A
t celll lymphoma
24
Q
pathophysiolgy of coeliac
A
mediated by t cells wihch exist in IELs, IEL ediated change leads to increasing loss of enterocytes wihch line intestines
25
tests for coeliac
biopsy
| IgA anti TTA
26
what is the cause of mesenteric ischaeima
embolus from AF blocking SMA
27
symtpoms of acute mesenteric ishccaeimi
gassless abdomen and cramping pain
28
tests of mesenteric ishcamei
metabolic acidosiss,
| CXR = bowel wall thickening
29
complications of mesenetic ischamei
repurfusion injury - causes inflammation
30
treatmnet for mesenteric ischaemia
fluids, met, gent
31
chronic mesenteric ischaemic symptoms
colicky post prandial pain, upper abdo bruit
32
tests for mesenteric ischaemi
CT angiogram, laparotomy
33
what causes meckels diverticulum
vitello - intestinal duct incomplete regression
34
rules of 2 for meckels diverticulum
2% of pop
2 inch long
2 feet from ileocaecal valve
males, presents before 2 years old
35
features of crohns
increased goblet cells, crypt absesses
36
where does crohns present
any part of GI tract but commonly the terminal ileum and proximal colon
37
tests for crohns
barium follow thorugh - shows cobblestoning
38
test for meckels diverticulum
radionucleotide scan, laparotomy
39
where does UC affectt
rectum
40
features of UC
goblet cell depletion
41
complications of UC
toxic megacolon - treat with IV hydrocortisone, LMWH, fluids
inx = abdo xray
tx = emergency colectomy
42
treatment of crohns and UC
1. 5SAS (masalazine) - only Uc
2. corticosteroids - prednisolone
3. immunosuppressents - azathioprine
4. anti TNF therapy - infliximab
43
treatment for smalll bowel obstruction
supine abdo xray
44
what genes are colorectal cancer assoc with
HPNCC and FAP iwth APC mutation
45
symtpoms of left sided colorectal canecr
fresh rectal bleeding and obstrctun, tenesmus
46
sympotms of right sided colorecatl cancer
anaemia, abdo pain
47
diagnostic scoring for colorectal canecr
```
DUKES
a - limited to mucosa
b - extends through muscularis mucosae
c - reginal lymph node involvement
d - distal mets
```
48
how to determine cause of jaundice
radiology
49
when does chronic liver disease occur
when hepatic stellate cells become activtaed and casue fibrosis
50
what is the path of NAFLD
steatosis - steatohepatitis - fibrosis - cirrhosis
51
inx for staeatosis
US
52
inx for NASH
liver biopsy
53
what destroys bile ducts in PBC
T cells
54
gillberts syndrome
congenital, unconjugated bilirubiemia
55
inx for PSC
ERCP
56
markers for autoimmune hep
SMA and ANA, IgG
57
treatment for autoimmune hep
corticosteroids (predisolone), azathioprine, useodeoxycholic acid
58
haemochrmatosis
increased ceruloplasm, iron overload
59
wilsons disease
decreased ceruloplasim, neurological and heaptic symptoms
60
A1AT symptoms
lung emphysema, liver deposition of mutant protein, cell damage
61
budd chiari
thrombosis of hepatic veins due to hypercoagulation
62
fulmaninat hepatic failure
severe hepatic failure in which encelopathy develops in under 2 weeks in a patient with a previously normal liver ,causedby hep a
63
physiology of cirrhosis
bands of fibrous tissue separating nodules of regenerative hepatocytes
64
invetsigations of haemangioma
US - echogenic spot, well demarcated
CT - venous enhancement form periphery to centre
MRI - high intensity area
65
what is the most common benign liver tumour
hemangioma
66
what is focal nodular hyperplasia
benign nodule formation of normal liver tissue - hyperplastic response to abnormal arterial flow
67
what are the investigations for focal nodular hyperplasia
US - nodule with varying echogenicity
CT - hyperplasic mass with central scar
MRI - iso or hypo intense
FNA - normal hepatocytes and kupffer cells with central core
68
what is hepatic adenoma
benign
| composed of normal hepatocytes, no portal tract, central veins or bile duct.
69
who normally gets hepatic adenoma
females
70
invetsigations of hepatic adenoma
US - fillling defect
CT - diffuse arterial enhancement
MRI - hypo or hyper intense lesion
FNA - may be needed
71
treatment of hepatic adenoma
stop hormones and lose weight
males = surgical excision
females <5cm/ reducing in size = annual MRI
>5cm/increasing = surgical excisoin
72
in hepatic adenoma, which gender has a bigger risk of malignant transformatoin
males
73
what is a hyatid cyst caused by
ecginococcus antibodies from undercoooked meat from street vendors or sheep parasites
74
treatment for hyatid cyst
conservative- open cystectomy
radical - pericystectomy
medical - albendazole
75
what is polystatic liver disease
embryonic ductal plate malforamtion of the intrahepatic biliary tree, numerous cysts throught liver parenchymal
76
treatment for polystatic liver disease
surgyer - patients with advanced liver failure
| pharmacological - somatostain analouges for symptom relief and liver volume reduction
77
what are the symptoms of liver abscess
leukocytosis, high fever, abdo pain, complex liver lesion
78
what causes liver abscesses
abdominal or biliary infection, dental procedure
79
invetsigation for liver abscess
echo
80
treamtent for liver abscess
broad spec empirical treatment with antibiotics + aspiration or drainage
81
what causes HCC
cirrhosis from hep b, c, alcohol, alfatoxin
82
how to investigate HCC
AFP >100
83
treatment for HCC
<5mc or less than 3 tumours which are less than 3cm = surgeyr liver transplant
84
cholethiasis def
stone formation in the gall bladder
85
what is cholecystitis
inflam of gallbladder, usually assoaciated with gallstone
86
symptoms of cholethiasis
colicky pain (comes and goes), worse with fatty foods
87
treatment of cholethiasis
elective cholecystectomy
88
symptoms of cholecystitis
made worse by eating, murphys sign
89
treatment of cholecystsitis
urgent cholecystectomy - ursodeoxycyclic aicd if unfit for surgery
90
choledocolithiasis def
gallstone lodged in common bile duct
91
treatment of choledocolithiasis
ERCP
92
treatment for gallstone ileus
urgernt laparotomy
93
what is biliary colic
when a gallstone temporarily blocks the cystic duct - constricts sphincter of oddi
94
how to treat biliary collic
morphine .. buprenophrine, lose weight
95
diagnostic score for pancreatitis
glasgow prognostic score "pacnreas" >3 = severe
96
how to treat pancreatitis
fluids, correct elecrolytes and P2
97
what organism infects pancreas
e coli
98
treatment for pacnreatic adenocarcinom
inoperable - ERCP or PTC adn stent insertion
| operable - laparoscopy and staging, ECRP stent
99
complete rectal prolapse treatment
bulking agent and education of manual reduction, delormes proceure, perineal rectopexy
100
incomplete rectal prolapse treatment
dietry advice and treatment of conspitaion (children) , treatment similar to haemorrhoids - sclerotiontherapy (adults)
101
GI bleeding scorea
blatchford score and rockall score
102
what causes an epigasic heria
weakness in linea alba- males
103
what is paediatric inguiinal hernia
<1 year olds males, common in preterm of LBW infants, processes vaginalis - <1s operate within 24 hours
104
femoral hernia def
females
| bowel enters femora canal, mass in upper medial thigh or above inguinal ligmanet, flattens groin crease
105
order of bundle in femoral hernia
NAV (Lateral to medial)
106
where is the femoral hernia in relatin to public tubercle
inferior and lateral
107
where is inguinal hernia in realtion to pubic tubercle
above and medial
108
if you cough and hernia returns, what is it
direct
109
how to treat campylobacter
azithromycin
110
complication of ecoli 1057
HUS
111
how to treat c diff
severe = vanco
| non- severe = oral metro
112
treatment and investiation of acute travellers diarrhoea
fluoroquinole single dose or azithroycin, stool culture
113
how to treat enteric fevre
empirical treatment - ceftriaxone
114
how to investigate amoebas
stoop microscopy
115
how to treat and investigate giardiasis
metro , stool microscopy
116
what oral ulcer presents with genital warts
bechets
117
what is hairy leukoplakia
shaggy, white, side of tongue HIV+ patietns and EBV
118
white patch you can rub off
candidias
119
gingivitis
vit c def, CCBs
120
bullk lax
ispagula husk, hyprophobic agetns eg polysaccharides, cellulose
used in mild/chronic diarrhoea assoc with diverticular disease or IBS
121
osmotic lax
lactulose/ macrogols
osmotically activae agents eg sugar, alcohol
use in bowel prop and hepatic encelopathy
caution in heart failure
122
stimulative laxative
eg semma, bisacodyl
increase elcetrolytes and thus water secretion from the colonic mucosa
use in constipate secondary to opioid use
123
anti emetics that act on CTZ
dopamine antagonists eg procholorperazine and metochloperamide
5HT3 receptor antagonists eg ondansetron
canabinoids
124
anti emetics that act on VN
H1 antihistmaies eg cyclizine
| anticholinergics eg hyosine
125
glycogenosis
glycogen synthesis from glucose
| glycogeniin, aloha4/6 glycosidic bonds, UDP glucose, glycogen synthase
126
glycogenolysis
breakdown of glycogen to form glucose
glycogen phosphorylase, glucose 6 phosphotase
occur sbetween meals to maintain BGL
127
glycogenolysis
the synthesis of glucose wihtin the body from non carb subsrates eg lactate, amino acids and glycerol
oxaloacetate 4c, TCA cycle, liver
occurs during prolonged periods of starvation eg overnight
128
gonnorhoea
direct contact of mucosal surfaces with infectious secreion
low abdo pain, diarrhoea, recatl bleeding, anal discharge
protoscopy - inflammed mucosa, purulent exudate
129
chlmaydia
anal discomfort / itch
| doxycyline
130
syphilus
oral sec
| ulcers in mouth, warrt like lesions
131
HSV
ano-genital or oral - genital
perianl mucosa
pain, ulcers, painful defacation, bleeding, mucus
132
HPV
anal warts
