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passmed facts > Upper and lower GI > Flashcards

Upper and lower GI Flashcards

1
Q

What should be monitored in post-op ileus?

A

Potassium, Magnesium and Phosphate (deranged electrolytes can contribute to post op ileum)

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2
Q

Management of Wilson’s disease?

A

Penicilliamine (mental chellating agent)

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3
Q

Type of inguinal hernia common in children?

A

Indirect inguinal hernia

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4
Q

1st line investigation for suspected perianal fissure in Chron’s?

A

MRI

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5
Q

Management of recurrent C. diff (within 12 weeks)?

A

Fidaxomicin

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6
Q

Cell change in Barret’s oesophagus?

A

Intestinal metaplasia

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7
Q

What testing is required in NAFLD to aid diagnosis of liver fibrosis?

A

ELF

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8
Q

NAFLD associated with?

A

Sudden weight loss

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9
Q

How do spider nevi fill compared to telangiectasia?

A

Spider nevi: from the centre
Telangiectasia: from the edge

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10
Q

Management of hiatus hernia?

A

PPI and weight loss
Surgery is rarely required, only a role in symptomatic paraoesophageal hernia

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11
Q

Initial management of abdominal wound dehiscence?

A

Coverage of wound with saline impregnated wound gauze and IV broad spectrum antibiotics

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12
Q

Neutrophil count from paracentesis to confirm SBP?

A

> 250

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13
Q

Most sensitive blood test in cirrhosis?

A

ALT

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14
Q

Which type of ulcer is most strongly associated with H. pylori?

A

Duodenal ulcer

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15
Q

Hernia between umbilicus and xiphisternum?

A

Epigastric hernia

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16
Q

Which antibiotic is associated with increased risk of C. Diff?

A

Clindamycin

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17
Q

Units =

A

(volume (mls) x %)/1000

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18
Q

Which 2 veins does trans jugular intra hepatic shunt connect?

A

Hepatic and portal

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19
Q

Crypt abscesses found in?

A

Ulcerative colitis

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20
Q

Mild C. diff features ?

A

Normall WCC

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21
Q

Moderate C. Diff features?

A

WCC (<15)
3-5 loose stools a day

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22
Q

Severe c diff features?

A

WCC (>15) or acutely raised creatinine (>50%)
Temp >38.5
Evidence of severe colitis (abdo/radio signs)

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23
Q

Life threatening c diff features?

A

Hypotension
Partial or complete ileus
Toxic megacolon
CT evidence of severe disease

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24
Q

Management of c diff (1st episode of infection)?

A

1st line: Vancomycin (10 days)
2nd line: oral findaxomicin
3rd line: oral vancomycin +/- IV metronidazole

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25
Q

Management of recurrent c diff?

A

Within 12 weeks: oral fidaxomicin
After 12 weeks: oral vancomycin or fidaxomicin

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26
Q

Management of life-threatening c diff?

A

Oral vancomycin and IV metronidazole

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27
Q

Malnutrition definition? (3)

A
  1. BMI < 18.5 or
  2. Unintentional weight loss > 10% within last 3-6months or
  3. BMI <20 and unintentional weight loss > 5% within last 3-6 months
28
Q

Management of gastric varicies (UGIB)?

A

Injection of N-butyl-2 cyanocrylate

29
Q

When do patients require a platelet transfusion in UGIB?

A

If actively bleeding and PLT < 50

30
Q

When to transfuse FFP in UGIB?

A

In patients who either have a fibrinogen level < 1g/L or activated partial thromboplastin time > 1.5x normal

31
Q

When to give prothrombin complex concentrate in UGIB?

A

In patients taking Warfarin and actively bleeding

32
Q

PPIs and endoscopy in UGIB?

A

NICE do NOT recommend the use of PPIs before endoscopy to patients with suspected no varriceal bleed
BUT
Patients should be given PPIs with non-variceal bleeding and stigmata of recent haemorrhage shown at endoscopy

33
Q

First line investigation in Budd-Chiari Syndrome?

A

USS with doppler (highly sensitive)

34
Q

Duration of post-exposure prophylaxis in HIV?

A

4 weeks
Started within 72 hours

35
Q

Vitamin B3 (niacin) deficiency?

A

Pellagra (diarrhoea, dementia, dermatitis)

36
Q

Liver haemangioma on USS?

A

Hyperechoic lesion
Normal AFP

37
Q

Investigation if dx of cholecystitis remains uncertain after USS?

A

Technetium-labelled HIDA scan

38
Q

Where should biopsy be taken for definitive diagnosis in Coeliac’s?

A

Jejunum

39
Q

TPN affect on blood tests?

A

Derranged LFTs

40
Q

Management of femoral hernias?

A

Need to be repaired, regardless of whether they are symptomatic, due to the risk of strangulation

41
Q

In what condition is amenorrhoea a common feature (and deranged LFTs)?

A

Autoimmune hepatitis

42
Q

How can you distinguish inguinal hernia types clinically?

A

Apply pressure to deep inguinal ring

43
Q

What cancer is strep Bovis associated with?

A

Colon cancer

44
Q

Where is most likely to be affected in ischaemic colitis?

A

Splenic flexure

45
Q

Features of achalasia?

A

Dysphagia of BOTH solid and liquids from onset
Regurgitation of food - cough, aspiration pnemonia

46
Q

What cancer does achalasia increase risk of?

A

Squamous cell carcinoma

47
Q

Drug used in obesity?

A

Orlistat (inhibiting pancreatic and gastric lipase to decrease digestion of fat)

48
Q

Management of umbilical vs inguinal hernia (paediatric)?

A

Inguinal: surgical repair immediately
Umbilical: Conservative management (may resolve spontaneously by 4-5 years)

49
Q

Bile acid malabsorption management?

A

Cholestyramine

50
Q

First line management for achlasia?

A

Pneumatic (balloon) dilation
2nd line = heller cardiomyotomy

51
Q

Increased goblet cells is in what IBD?

A

Crohn’s

52
Q

Complication of coeliacs?

A

Hyposplenism

53
Q

Most common cause of large bowel obstruction?

A

Bowel cancer

54
Q

Imaging used to ensure no anastomotic leak following surgery?

A

Gastrogafin enema

55
Q

Pseudomembranous colitis?

A

C. diff
Clindamycin and cephalosporins cause it

56
Q

Management of patient with ascites and protein count is < /= 15g/l?

A

Ciprofloxacin - for SBP

57
Q

Cause of gas gangrene?

A

Clostridium perfrigens

58
Q

Management of biliary colic ?

A

Elective lap cholecystectomy

59
Q

Score for frailty assessment?

A

Prisma-7

60
Q

What score do nice recommend is calculated every 6 months in patients with compensated liver disease?
And other monitoring?

A

Meld score

AFP and USS also every 6 months
OGD every 3 months

61
Q

WHO what is sign in?

A

Before anaesthesia

62
Q

What is time out? (WHO)

A

Before skin incision

63
Q

WHO what is sign out?

A

Before patient leaves theatre

64
Q

Sister Mary Joseph nodule?

A

Sign of metastasis to periumbilical lymph nodes, classically from gastric cancer primary

65
Q

What drug increases risk of perforation in diverticulitis?

A

Nicorandil - causes gi ulceration

passmed facts (18 decks)

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