Quesmed GI Flashcards
What will cool so y show for Crohn’s?
Rose thorn ulcers due to transmural inflammation
Non-caesating granuloma
Cobblestone mucosa
What should be assessed prior to Azathriopine therapy for Crohn’s?
Tiopurine methyltransferase activity, as under activity will increase the risk of bone marrow suppression
What causes a high AST:ALT ratio, elevated GGT and hypoalbuminaemia?
Alcoholic liver disease
What are the features of carcinoid tumour?
Diarrhoea, hypotension, wheezing and flushing from tumour of endocrine cells
Which cardiac pathology occurs with carcinoid tumours?
Pulmonary stenosis due to right sided valvular stenosis from the effect of serotonin. Tricuspid regurgitation is a less likely slide effect
What is carcinoid syndrome assocated with?
Pellagra which causes the 4 D’s:
Dermatitis on sun exposed areas on the skin as a red rash
Diarrhoea
Dementia with confusion
Death
What is a low SAAG?
Less than 11 g/l
What is the best prognostic indicator for fulminant hepatitis due to paracetomol overdose?
INR
Represents the synthetic function of the liver
What does albumin indicate
It has a half life of three weeks and is a better indicator of subacute liver function
Does the PTT change with liver damage?
No
-> PT is prolonged but PTT is relatively unaffected
What condition causes dysphagia, fatigue, paleness, brittle nails, pale and glossitis?
Plummer Vinson Syndrome
How does Budd-chairing present?
Severe abdominal pain
Ascites
Tender hepatomegaly
What is the gold standard for diagnosis of Budd chairi?
Abdominal ultrasound
Doppler
What should be avoided in toxic megacolon?
NSAIDs
Opiates
Anticholinergic
-> reduce motility and increase risk of perforation
What is an emergency complication of ulcerative colitis?
Toxic megacolon with abdominal distention and pain
What is first line for gastroparesis?
Metoclopramide and domperidone
What is a dermatological manifestation of Crohn’s disease?
Pyoderma gangrenosoum with large painful ulcers in the elgs
Which medication causes acute pancreatitis?
Furosemide and thiazide diuretics
Azathriopine
Sodium valproate
Tetracycline
ACE inhibitors
What can cause a false negative anti-TTG result with coeliac?
IgA deficiency
What test should confirm diagnosis of coeliac?
Jejunum biopsy
What is first line for ascites in liver cirrhosis?
Spironolactone
What is second line for ascites in sin liver cirrhosis?
Furosemide
How does campylobacter jejuni infection present?
spiral or comma-shaped gram-negative organism, which commonly presents with a flu-like prodrome, crampy abdominal pain, and bloody diarrhoea. It is a common cause of food poisoning and can have an incubation period as long as five days
What is campylobacter jejuni infection associated with?
Guillan barre syndrome, with ascending bilateral weakness in lower limbs
What organism causes diarrhoea and rose coloured spots on the periumbilical region?
Typhoid fever which has a high risk of intestinal perforation and GI ulceration. Initial symptoms are diarrhoea and fever and progressses to delirium and abdominal pain.
What cases bloody diarrhoea?
Campylobacter jejuni
E.Coli
Shigella
Salmonella enteric typhi and paratyphi
Norovirus
What is the management of patients with low grade dysplasia fo oesophagus?
High dose Omeprazole and SIX monthly endoscopic surveillance
What is the management of patients with high grade dysplasia of oesophagus?
Endoscopic ablation
How does acute porphyria present?
Abdominal pain
Muscle weakness confusion
Seizures
What is a common side effect following treatment of giardiasis?
Lactose intolerance with bloating, abdominal discomfort and flatulence
Which systems are mainly affected in Wilson’s disease?
Liver and Brian
What causes GGT to be raised?
Diabetes
Pancreatic disease
Cholestasis liver disease
What causes a metallic taste in the mouth as part of H.pylroi treatment?
Metronidazole
What is a side effect of bismuth?
Blac stools and occasional constipation
What is the syndrome with haemochromatosis?
Erectile dysfunction
Type 1 diabetes
Painful joint presenting as pseudo gout
What is the best initial investigation of haemochromtosis?
Transferrin saturation
What is the genetic test for haemochromtosis?
C282Y mutation in the HFE gene
What maintains remission of Cron’s?
Azathriopine
-> patients should have thipurine methyltransferase levels checked
What is the gold standard for NAFLD?
Liver biopsy for staging
-> fibroscan is a preferable non invasive method
How does coeliac disease affect FBC?
Causes Macrocytic anaemia with hyposplenism (Howell-jolly bodies) and thrombocytosis
What causes epigastric pain worst on waking and relieved by eating?
Duodenal ulcers
What does HBeAg indicate?
Viral load
-> when it is positive, there is a high viral load
What does anti-HBc mean?
Past or current ensure to hepatitis B
It is seroconversion with chronic infection with resolution
Which drug for NAFLD?
Piagitazone which activates PPAR for anti-inflammatory and insulin-sensitising effect
What predicts poor prognosis for acute liver failure?
King’s college criteria based on
What predicts poor prognosis for acute liver failure?
INR over 6.5
PT over 100
Serum creatinine over 300
Grade III or IV hepatic encephaloapthy
Arterial pH less than 7.3 24 hours post araceotmol overdose
How does Duputren’s contracture present?
Tender nodule with flexed flexion of little and ring finger.
Related to chronic alcohol intake or repeated hand trauma
What is the most common hepatits in the uK?
Hepatitis C
How does Alcohlic hepatitis present?
Fever and confusion with:
jaundice, elevated liver enzymes with an AST>ALT ratio typically greater than 2
What is given for mild flare of ulcerative colitis?
Mesalsalazine enema
When is prednisolone given for UC?
Second INR to mesasalazine
Severe flare
-> anaemia and raised inflammatory markers
Passing more than 4 stools per day
What is the appropriate intervention after fluids and blood transfusion for variceal bleeding?
Terlipressin, a vasopressin analogue for spinach IC vasoconstriction
Antibiotics regardless of infection confirmation that cover gram negative bacteria
What is an alternative to Terlipressin?
Ocreotide
What condition occurs with UGT1A1 gene mutation?
Gilbert;;s syndrome
What condition occurs with UDP-glucuronosyltransferase enzyme deficiency?
Crigler-Najjar syndorme
What is given as an anti-emetic for chemotherapy?
5HT3 antagonist like ondansetron
5
What is the criteria for 2 week endoscopy to rule out gastric cancer?
Patients over 55 with weight loss and:
Upper abdominal pain
OR
Reflux
OR
Dyspepsia
What type of ulcer is most common with H. Pylori?
90% cause of Duodenal ulcer
-> gastric ulcers is 80% and can have other causes but at least
What is the management of uncomplicated sliding hiatal hernia?
PPI and lifestyle advice in the absence of:
Haemorrhage
Volvos/ischameia/necrosis
What his the gold standard for coeliac?
Endoscopy wit duodenal biopsy
What is the cause of gastric MALTOMA?
Helicobacter Pylori
Chronic inflammation
What promotes smooth muscle relaxation in digestive system including oesophagus?
PROGESTERONE
What i the first line for hepatitis C?
Direct acting antivirals like sofosbuvir, ledipasvir and velpatasivir
-> pegylated interferons are not recommended for hep C
What is pegylated interferon used for?
Hepatitis B
What is Whipple’s disease?
Tropheryma Whipple I bacteria infection causing joint pain, diarrhoea and abdominal pain. There will be positive acid-Schaffer antibodies.
How is Whipple’s disease managed?
Co-trimozazole
What causes Mucosal oedema and erythema, widespread ulceration, spontaneous bleeding?
Ulcerative colitis
Multiple epithelial growths across the colonic mucosa
FAP
What causes an inflamed opening in the skin surrounding the anus?
Peri anal fistula which is the most common type of fistula
What are the risk factors for Whipple’s disease?
Male over 50
Genetic predisposition
How is a perianal fistula managed?
Metronidazole antibiotic or ciprofloxacin
What is an enterococci fistula?
Abnormal tract between two parts of the bowel
What causes blueish bulging vessels?
Haemorrhoid
What s the first line treatment for gastroparesis?
Domperidone D2 antagonist
AVOID in patient with prolonged QT interval
What is a sensitivity GI agnostic for hiatus hernia?
barium swallow for upper GI
What causes gurgling sound on palpation and dysphagia?
Pharyngeal pouch
What
What is the cause of dark brown pigment macrophages in lamina propia of coon?
Melanonosis coli,a sscoiated with laxatives containing senna
What is the cause of pyoderma gangrenosium?
Crohn’s disease
Ulcerative colitis
What are the physical findings of oestrogen at high levels?
Palmar erythema
Spider naevi
Gynaecomastia
What is used for primary prophylaxis of variceal bleeding?
Non selective beta blocker
Variceal band ligation
Which organisms cause spontaneous bacterial peritonitis?
Kliebsella pneumonia
E.Coli
What is the most important indicator for urgent liver transplant?
PT over 100 seconds
What is given for bowel obstruction?
Metacloprmide which stimulates bowel movements and is an anti-emetic
What should be avoided in bowel obstruction?
Isphagala husk
Which medication is given for carcinoid?
Ocreotide
What are common systemic effects of haemochromatosis?
diabetes type 2
Hypogonadism Ophir hypogonadism
Arthritis
Cardiac fialure
What is the calcium value in Gaslgow imrie score?
Calcium less than 2.0
How should patients be managed with dyspepsia and failure to relive with PPI in the absence of weight loss?
Urea breath test for H.pylori
What does CA19-9 indicate?
pancreatic cancer
Gall bladder cancer
Bile duct cancer
Gastric cancer
What does CA15-3 indicate?
Breast cancer screening
What is used to screen hepatitis C?
CA15-3
How do patients present with giardiasis?
non-bloody diarrhoea and pale, floating stools after an incubation period of 1-3 weeks
