Upper and lower GI Flashcards
What should be monitored in post-op ileus?
Potassium, Magnesium and Phosphate (deranged electrolytes can contribute to post op ileum)
Management of Wilson’s disease?
Penicilliamine (mental chellating agent)
Type of inguinal hernia common in children?
Indirect inguinal hernia
1st line investigation for suspected perianal fissure in Chron’s?
MRI
Management of recurrent C. diff (within 12 weeks)?
Fidaxomicin
Cell change in Barret’s oesophagus?
Intestinal metaplasia
What testing is required in NAFLD to aid diagnosis of liver fibrosis?
ELF
NAFLD associated with?
Sudden weight loss
How do spider nevi fill compared to telangiectasia?
Spider nevi: from the centre
Telangiectasia: from the edge
Management of hiatus hernia?
PPI and weight loss
Surgery is rarely required, only a role in symptomatic paraoesophageal hernia
Initial management of abdominal wound dehiscence?
Coverage of wound with saline impregnated wound gauze and IV broad spectrum antibiotics
Neutrophil count from paracentesis to confirm SBP?
> 250
Most sensitive blood test in cirrhosis?
ALT
Which type of ulcer is most strongly associated with H. pylori?
Duodenal ulcer
Hernia between umbilicus and xiphisternum?
Epigastric hernia
Which antibiotic is associated with increased risk of C. Diff?
Clindamycin
Units =
(volume (mls) x %)/1000
Which 2 veins does trans jugular intra hepatic shunt connect?
Hepatic and portal
Crypt abscesses found in?
Ulcerative colitis
Mild C. diff features ?
Normall WCC
Moderate C. Diff features?
WCC (<15)
3-5 loose stools a day
Severe c diff features?
WCC (>15) or acutely raised creatinine (>50%)
Temp >38.5
Evidence of severe colitis (abdo/radio signs)
Life threatening c diff features?
Hypotension
Partial or complete ileus
Toxic megacolon
CT evidence of severe disease
Management of c diff (1st episode of infection)?
1st line: Vancomycin (10 days)
2nd line: oral findaxomicin
3rd line: oral vancomycin +/- IV metronidazole
Management of recurrent c diff?
Within 12 weeks: oral fidaxomicin
After 12 weeks: oral vancomycin or fidaxomicin
Management of life-threatening c diff?
Oral vancomycin and IV metronidazole
Malnutrition definition? (3)
- BMI < 18.5 or
- Unintentional weight loss > 10% within last 3-6months or
- BMI <20 and unintentional weight loss > 5% within last 3-6 months
Management of gastric varicies (UGIB)?
Injection of N-butyl-2 cyanocrylate
When do patients require a platelet transfusion in UGIB?
If actively bleeding and PLT < 50
When to transfuse FFP in UGIB?
In patients who either have a fibrinogen level < 1g/L or activated partial thromboplastin time > 1.5x normal
When to give prothrombin complex concentrate in UGIB?
In patients taking Warfarin and actively bleeding
PPIs and endoscopy in UGIB?
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
First line investigation in Budd-Chiari Syndrome?
USS with doppler (highly sensitive)
Duration of post-exposure prophylaxis in HIV?
4 weeks
Started within 72 hours
Vitamin B3 (niacin) deficiency?
Pellagra (diarrhoea, dementia, dermatitis)
Liver haemangioma on USS?
Hyperechoic lesion
Normal AFP
Investigation if dx of cholecystitis remains uncertain after USS?
Technetium-labelled HIDA scan
Where should biopsy be taken for definitive diagnosis in Coeliac’s?
Jejunum
TPN affect on blood tests?
Derranged LFTs
Management of femoral hernias?
Need to be repaired, regardless of whether they are symptomatic, due to the risk of strangulation
In what condition is amenorrhoea a common feature (and deranged LFTs)?
Autoimmune hepatitis
How can you distinguish inguinal hernia types clinically?
Apply pressure to deep inguinal ring
What cancer is strep Bovis associated with?
Colon cancer
Where is most likely to be affected in ischaemic colitis?
Splenic flexure
Features of achalasia?
Dysphagia of BOTH solid and liquids from onset
Regurgitation of food - cough, aspiration pnemonia
What cancer does achalasia increase risk of?
Squamous cell carcinoma
Drug used in obesity?
Orlistat (inhibiting pancreatic and gastric lipase to decrease digestion of fat)
Management of umbilical vs inguinal hernia (paediatric)?
Inguinal: surgical repair immediately
Umbilical: Conservative management (may resolve spontaneously by 4-5 years)
Bile acid malabsorption management?
Cholestyramine
First line management for achlasia?
Pneumatic (balloon) dilation
2nd line = heller cardiomyotomy
Increased goblet cells is in what IBD?
Crohn’s
Complication of coeliacs?
Hyposplenism
Most common cause of large bowel obstruction?
Bowel cancer
Imaging used to ensure no anastomotic leak following surgery?
Gastrogafin enema
Pseudomembranous colitis?
C. diff
Clindamycin and cephalosporins cause it
Management of patient with ascites and protein count is < /= 15g/l?
Ciprofloxacin - for SBP
Cause of gas gangrene?
Clostridium perfrigens
Management of biliary colic ?
Elective lap cholecystectomy
Score for frailty assessment?
Prisma-7
What score do nice recommend is calculated every 6 months in patients with compensated liver disease?
And other monitoring?
Meld score
AFP and USS also every 6 months
OGD every 3 months
WHO what is sign in?
Before anaesthesia
What is time out? (WHO)
Before skin incision
WHO what is sign out?
Before patient leaves theatre
Sister Mary Joseph nodule?
Sign of metastasis to periumbilical lymph nodes, classically from gastric cancer primary
What drug increases risk of perforation in diverticulitis?
Nicorandil - causes gi ulceration
