Randoma Ass Facts For Gastro Flashcards by Rosie Glendinning

More common characteristics of ulcerative colitis compared to other types of IBD?

continuous disease
bloody diarrhoea
abdo pain in left lower quadrant
Tenesmus - feeling of not being able to empty large bowel even if there is no remaining stool left
depletion of goblet cells
crypt abscesses
loss of haustrations on barium enema
primary sclerosing cholangitis
no inflammation beyond submucosa
inflammation starting at the rectum and not spreading beyond the ileocaecal valve
drainpipe colon
pseudopolyps seen on endoscopy

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More common characteristics of Crohns disease compared to other types of IBD?

usually non-bloody diarrhoea
weight loss
upper GI symptoms: mouth ulcers, perinanal disease
abdominal mass palpable in the right iliac fossa
increased goblet cells
gall stones
granulomas
Kantor’s string sign
oxalate renal stones
inflammation in all layer from the mucosa to the serosa
deep ulcers, skip lesions (‘cobble stone’) appearance on endoscopy

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Right upper quadrant pain, fever, jaundice in a question is most likely to indicate:

Ascending cholangitis

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Stereotypical history for Coeliac disease

Foul smelling oily diarrhoea
abdominal bloating
fatigue
weight loss
On examination: papulovesicular lesions on the extensor aspects of patients arms

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Stereotypical history of IBS

recurrent episodes of abdominal pain associated with bloating
pain is relieved on defecation
normally passes 3 loose stools with mucous in the mornings

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Typical Acute cholecystitis history

50-year-old woman presents with constant right upper quadrant pain. She has a history of gallstones. She is pyrexial and has raised inflammatory markers

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Typical Ascending cholangitis history

a 50-year-old woman presents with constant right upper quadrant pain, fever and yellowing of the sclera. She has a history of gallstones. She is jaundiced, pyrexial and has raised inflammatory markers

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Typical history of Biliary colic

a 45-year-old woman presents with intermittent right upper quadrant pain after eating a large meal. Inflammatory markers, pulse and temperature are normal

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Typical history of Intestinal obstruction

a 40-year-old woman with a history of Crohn’s disease presents with central abdominal pain, vomiting and not opening her bowels for 24 hours

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Typical history of acute pancreatitis

a 40-year-old man with a history of alcohol excess presents with severe epigastric pain. Serum lipase levels are elevated

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Painless jaundice, steatorrhoea (presence of fat in faeces) in a question is most likely to indicate:

Pancreatic cancer

Aswell as anorexia, weight loss

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Stereotypical history of a duodenal ulcer

a 50-year-old man presents with epigastric pain relieved by eating

a 40-year-old man with a history of back pain presents with epigastric pain and passing black, tarry stools. His pain is relieved by eating

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Stereotypical history of a gastric ulcer

a 50-year-old man presents with epigastric pain worsened by eating

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What is characteristics of haemochromatosis?

Arthritis
diabetes Mellitus
dilated cardiomyopathy
bronze skin pigmentation

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What does femoral (groin) hernias and directs inguinal hernias have in common?

They are very rare in children

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What is a direct inguinal hernia caused by?

A decent or weakness in the transversalis fascia of the Hesselbach triangle

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Coeliac disease is most associated with what complications?

Lactose intolerance
osteomalacia, osteoporosis
subfertility, unfavourable pregnancy outcomes
hyposplenism
anaemia: iron, folate, vitamin B12 def.
enteropathy-associated T-cell lymphoma of small intestine
- small bowel lymphoma
rare: oesophageal cancer, other malignancies

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What dos the splenorenal contain?

The tail of the pancreas

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What is the main mechanism of cation of Omeprazole?

Irreversible blockade of H+/K ATPase

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What does a direct inguinal hernia posterior to?

The inferior epigastric artery

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Typical history of a ruptured abdominal aortic aneurysm

An elderly man presents with severe central abdominal pain radiating to the back associated with hypotension

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A 50-year-old obese man with a history of type 2 diabetes mellitus is noted to have mild hepatomegaly on examination. He drinks one glass of wine per week. Blood tests show a slightly raised ALT and a liver ultrasound shows increased echogenicity is a stereotypical history of:

Non-alcoholic fatty liver disease

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an obese 50-year-old woman presents with pain in the RUQ which radiates to the interscapular region. She is apyrexial and not jaundiced

What is this a stereotypical history of?

Biliary colic

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a 55-year-old presents with RUQ pain, fever and jaundice. His blood pressure is 98/60 mmHg and he appears slightly confused

What is this a stereotypical history for?

Ascending cholangitis
- right upper quadrant pain, fever, jaundice

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Severe central abdominal pain, history of alcohol or gallstones in a question is most likely to indicate?

Acute pancreatitis

What are typical features of primary biliary cholangitis

middle aged female, fatigue, pruritus (itch), raised IgM

a 40-year-old man presents with severe pain on the right side of his back. This comes in waves. On examination he is restless with blood+ on the urine dipstick What is this a typical history of?

Renal colic

a 35-year-old woman presents with pain on the right side of her back. This is constant and associated with fever and rigors What is this a typical history of?

Acute pyelonephritis

A 70-year-old man is taken to the emergency department after collapsing with severe central abdominal pain. On examination he is hypotensive and tachycardia is a stereotypical history of?

Ruptures abdominal aortic aneurysm

What is the Hindgut? (Embryology)

The embryological origin of the descending colon

What is the midgut? (Embryology)

Embryological origin of the proximal 2/3rds of the transverse colon

What so the first lime treatment for peptic ulcer disease (acute bleeding)?

Endoscopic intervention - aids in confirming the diagnosis and identifying the cause of bleeding, as well as stopping the bleeding. Adrenaline is injected into the bleeding site, together with cautery and/or clip application.

How can chronic pancreatitis cause diabetes?

Due to destruction of the islet of Langerhans cells of the pancreas

What is Courvoisier's law?

in the presence of painless obstructive jaundice, a palpable gallbladder is unlikely to be due to gallstones

What are the main differentiating factor between rectal cancer and duodenal cancer in relations to the presence of fresh blood?

Fresh blood indicates a lower gastrointestinal bleed therefore rectal cancer (an upper bleed would present with melaena - dark black, tarry faeces).

What does Gastroenteritis presents with?

- Vomiting - Diarrhoea - Fever

Features of acute pancreatitis?

- severe epigastric pain that may radiate through to the back - vomiting is common - examination may reveal epigastric tenderness, ileus and low-grade fever - periumbilical discolouration (Cullen's sign) and flank discolouration (Grey-Turner's sign) is described but rare

What is the mechanism of diphenoxylate?

Diphenoxylate acts on μ-opioid receptors in the GI tract to slow down peristalsis

A combination of liver and neurological disease points towards what disease?

Wilson’s disease

a middle-aged patient presents with dysphagia of both liquids and solids from the start. They also complain of regurgitation and a persistent cough What is this a typical history of

Achalasia

a patient with a known history of Barrett's oesophagus presents with dysphagia and weight loss What is this a typical history of?

Oesophageal cancer

an elderly patient presents with watery diarrhoea after being treated for pneumonia. Blood tests show a new, marked neutrophilia What is this a typical history of?

Clostridium difficile

What is characteristic of Wilsons disease?

- asterixis - haemolytic anaemia - renal tubular acidosis - blue nails

When testing for hepatitis B, HBsAg positive, anti-HBs negative, IgG anti-HBc positive, IgM anti-HBc negative indicates?

Chronic infection

a 65-year-old man with a history of chronic hepatitis b infection presents with symptoms and signs of liver cirrhosis. Alpha-fetoprotein is elevated. What is this a typical history of?

Hepatocellular carcinoma

What is most characteristic of primary biliary cirrhosis?

- anti-mitrochondrial antibodies

a 40-year-old man presents with severe pain on the right side of his back. This comes in waves. On examination he is restless with blood+ on the urine dipstick What is this a typical history of?

Renal colic

a 70-year-old man with a history of benign prostatic hyperplasia presents with constant, severe suprapubic pain What is this a typical sign of?

Urinary retention

a 20-year-old woman presents with diarrhoea. Over the past few months she has lost weight and suffered with recurrent abdominal pain and mouth ulcers What is this a typical history of?

Crohns disease

a 70-year-old woman presents with left lower quadrant pain. She reports diarrhoea with one episode of blood. On examination she is pyrexial and has raised inflammatory markers What is this a typical history of?

Acute diverticulitis

What peritoneal ligament contains the short gastric vessels?

Gastrosplenic

What peritoneal ligament contains the hepatic artery, hepatic portal vein and common bile duct?

Hepatoduodenal ligament

True or false indirect and direct inguinal hernias are more common in females?

False!! More common in **males**

What inguinal hernias are at **low** risk if strangulation?

Direct inguinal hernias Indirect inguinal hernias **NOT** Femoral hernias, these are at high risk

a 9-month-old boy presents with vomiting and passing blood stained stools. His parents describe regular 'colicky' episodes during which he draws his knees up and appears pale. On examination there is a sausage-shaped mass in the abdomen What is this a typical history of?

Intussusception

a 3-month-old infant presents with vomiting and regurgitation following feeds. The child is gaining weight normally and no abnormalities are found on examination What is this a typical history of?

Gastrointestinal-oesophageal reflux disease

A 65-year-old woman presents with jaundice, weight loss and passing clay-coloured stools. She also describes recurrent bouts of colicky RUQ abdominal pain. On examination a mass is palpable in the RUQ is a stereotypical history of?

Cholangiocarcinoma

an overweight 45-year-old woman presents with recurrent episodes of right upper quadrant pain that is made worse by eating a fatty meal What is this a typical history of?

Biliary colic

An elderly man complains of dysphagia, halitosis, regurgitation and cough is a stereotypical history for?

Pharyngeal pouch

a patient who is known to have HIV presents with odynophagia What is this a typical history of?

Oesophageal candidiasis

A 1-year-old boy with a recent history of rectal bleeding presents with intestinal obstruction. During surgery he is found to have a omphalomesenteric band is a stereotypical history of?

Meckel's diverticulum

a 10-day-old baby boy presents with abdominal distension and vomiting. He first passed meconium at 72 hours and has not opened is bowels since. An abdominal x-ray shows a dilated colon What is this a typical history of?

Hirchsprungs disease

A 12-month-old develops profuse watery diarrhoea associated with a low-grade fever. A number of other children at his day-care centre have similar symptoms is a stereotypical history for infection by?

Rotavirus

Strong family history of colorectal and endometrial cancer in a question is most likely to indicate?

Hereditary non-polyposis colorectal carcinoma

What best describes the mechanism of action of rantidine?

H2 antagonist

What best describes the mechanism of action of Exetimibe?

Inhibits cholesterol receptors on enterocytes, decreasing cholesterol absorption in the small intestine

A woman complains of lethargy, diplopia and dysphagia. She is noted to have a ptosis on examination is a stereotypical history for?

Myasthenia gravis

A 40-year-old woman is investigated for dysphagia. Oesophageal manometry shows decreased oesophageal peristalsis and decreased lower oesophageal sphincter tone What is this a typical history of?

Systemic sclerosis

A 40-year-old alcoholic presents with haematemesis after repeated episodes of vomiting. An endoscopy two months ago showed no evidence of varices is a stereotypical history for?

Mallory-Weiss syndrome

What does Helicobacter Pylori produce to aid in survival?

Produces urease

Immunisation is not possible and reinfection is common due to antigen variation of type IV pili (proteins which adhere to surfaces) and Opa proteins What bacteria does this suggest?

N. Gonorrhoeae

What type of cancer is most associated what Helicobacter pylori

B cell lymphoma of MALT tissue

What best describes the mechanism of action of loperamide and diphenoxylate?

Opioid receptor agonist

What best describes the mechanism of action of theophylline?

Non-specific inhibitor of phosphodiesterase resulting in an increase in cAMP

Anterior resection of rectum is associated with injury to which nerve?

Hypogastric autonomic nerves

Inguinal hernia surgery is associated with injury to which nerve?

Ilioinguinal nerve

Recent antibiotic use, profuse diarrhoea, high white cell count in a question is most likely to indicate?

Clostridium difficile infection

The drug cholestyramine is most likely to be used for?

Hyperlipidaemia - decreases bile acid reabsorption in the small intestine, therefore upregulating the amount of cholesterol that is converted to bile acid. The main effect it has on the lipid profile is to reduce LDL cholesterol. It is also occasionally used in Crohn's disease for treatment diarrhoea following bowel resection.

a 65-year-old man with a history of chronic hepatitis b infection presents with symptoms and signs of liver cirrhosis. Alpha-fetoprotein is elevated. What does this history represent?

Hepatocellular carcinoma

a 60-year-old woman with a history of polycythaemia rubra vera presents with abdominal pain and distension. She is found to have ascites and hepatomegaly on examination What does this history represent?

Budd-Chiari syndrome

Randoma Ass Facts For Gastro Flashcards

(80 cards)