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Third year > Week 13 - GI > Flashcards

Week 13 - GI Flashcards

1
Q

What is a peptic ulcer?

A

A break in the mucosal lining, more than 5mm diameter and depth to the submucosa

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2
Q

What skin conditions is associated with coeliac disease?

A

Dermatitis herpetiformis

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3
Q

What infection might patients with cirrhotic liver disease get?

A

Spontaneous bacterial peritonitis - associated with spontaneous infection of ascites

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4
Q

What is an acute abdomen?

A

Sudden onset of severe abdominal pain of less than 24 hours duration.
RUQ- biliary colic, acute cholangitis
RIF - ectopic pregnancy, acute appendicitis, ovarian cyst

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5
Q

What are consequences of peptic ulceration?

A

Haemorrhage, perforation, fibrosis

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6
Q

What characterises diffuse gastric cancer?

A 
Linitis plastica (leather bottle stomach) 
(also has signet ring cells- malignancy with mucin vacuoles)
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7
Q

What drug is a risk factor for gallstones?

A

Ceftriaxone

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8
Q

What tumour marker would indicate pancreatic cancer?

A

CA19-9

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9
Q

What tumour marker is present in colorectal cancer?

A

Carcinomembryonic antigen

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10
Q

What tumour marker is present in hepatocellular carcinoma?

A

Alpha-fetoprotein

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11
Q

What score assesses severity of liver cirrhosis?

A

Child-turcotte-pugh score

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12
Q

What antibiotic is used in spontaneous bacteria peritonitis?

A

Ciprofloxacin

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13
Q

What hepatitis is associated with travel?

A

Hepatitis A

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14
Q

What type of vaccine is the hepatitis A?

A

Inactivated virus

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15
Q

What can Hepatitis E cause in pregnant women?

A

Fulminant hepatitis

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16
Q

What does Hep D need to survive?

A

Hepatitis B

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17
Q

What might augmentin cause?

A

Acute cholestatic hepatitis

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18
Q

Give an example of a liver cyst.

A

Von meyenberg complex (simple biliary hamartoma)

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19
Q

What can itching be a sign of? (GI)

A

Primary biliary cirrhosis

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20
Q

What might coeliac disease cause?

A

Enteropathy associated T cell lymphoma

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21
Q

What does T3 mean?

A

Invasion through the muscular propria and into the sub-serosa or non-peritonelaised pericolic tissue

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22
Q

What condition might present with aphthous oral ulcers?

A

Ulcerative colitis

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23
Q

What drugs would you give in a patient with frequently severe relapses of UC? and what is a risk of it?

A

Azathioprine/6-mercaptopurine

Risk of lymphoma

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24
Q

What is Crohn’s disease?

A

Chronic, transmural, inflammatory granulomatous disease from mouth to anus.

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25
Q

What acute changes are seen in IBD?

A

Ulceration, crypt abscess formation, loss og goblet cells. acute inflammation

26
Q

What is localised peritonisitis caused by?

A

Underlying organ inflammation - appendicitis or cholecysitis

27
Q

What is generalised peritonitis caused by?

A

Perforation of an abdominal organ - perforated duodenal ulcer, ruptured appendix

28
Q

What drugs may cause cirrhosis?

A

Amiodarone, methotrexate, Na valproate

29
Q

What might cause hepatic encephalopathy?

A

GI bleeding, infections, constipation, electrolyte imbalance

30
Q

What might be a complication of Coeliac disease?

A

T cell lymphoma

Infections, osteoporosis, refractory coeliac disease, malignancy (adenocarcinomas - bowel, oesophagus)

31
Q

What is a complication of C.Diff infection?

A

Pseudomembranous colitis

Toxic megacolon

32
Q

How might you differentiate between inflammatory bowel disease and irritable bowel syndrome?

A

Faecal calprotectin
Calcium binding protein derived from neutrophils
Not disease specific

33
Q

How might infective colitis present?

A 
Short history of diarrhoea ± vomiting
Abrupt onset ± resolution of Sx
Systemic upset and fever
Travel, ill contacts, immunocompromised.
Stool culture and C.diff toxin assay (need 4)
34
Q

How might ischaemic colitis present?

A

Abrupt onset pain, bloody diarrhoea ± SIRS
IV fluids ± antibiotics
CV disease, Heart failure, elderly

35
Q

What does ‘Back wash ileitis’ mean?

A

When the terminal ileum is involved in Ulcerative colitis

severe cases

36
Q

What type of oesophageal cancer is smoking and drinking associated with?
What is the other type?

A

Squamous carcinoma

Adenocarcinoma - GORD and obesity

37
Q

When would you use the Seattle protocol?

A

Diagnosing Barretts oesophagus

4 biopsies every 2cm

38
Q

What type of cells are seen in Diffuse gastric cancer that can be described as ‘individual malignant cells with mucin vacuoles’.

A

Signet ring cells

39
Q

What are the types of gastric cancer?

A

Diffuse - Women <50 (signet ring cells)

Intestinal - Elderly men (end result of inflammation causing dysplasia)

40
Q

What is the Glasgow-Blatchford score used for?

A

Based on clinical presentation. Risk of having an upper GI bleed, in a suspected bleed. > 0 is high risk

41
Q

What is the Rockall score used for?

A

Calculates the risk of a re-bleed if patients get endoscopied

42
Q

How might someone with an upper GI bleed present?

ABATED for upper GI bleed management

A

Melaena, coffee ground vomit, haematemesis, haemodynamic instability

43
Q

How would you manage a patient with variceal bleeding?

A
  1. Restore circulating volume, transfuse once Hb <7g/dL
  2. Endoscopy
  3. Ciprofloxacin + Terlipressin, endoscopic banding (1st Line), TIPS
44
Q

What would you give for prophylaxis of variceal bleeding?

A

Beta blockers or band ligation

Same for prevention of re-bleed

45
Q

How would you manage uncontrolled variceal bleeding?

A

Sengstaken tube

46
Q

Define Tenesnus.

A

A feeling of fullness in the rectum even after opening your bowels

47
Q

Who would get screened for bowel cancer?

A

50-74 every 2 years
Faecal immunochemistry test to look for human Hb
Then 2 weeks wait referral to colonoscopy

48
Q

What are the options for pre-exposure prophylaxis to Hep A?

Hep A can cause Acute liver failure

A

Inactivated virus - Hep A vaccine

If vaccine allergic. <4 weeks to travel, confers 3-6 months immunity - Hep A immunoglobulin - Pooled Ig

49
Q

Hepatitis E can cause neurologic features, give an example.

A

Guillain barre syndrome

50
Q

How would you treat Hep E?

A

Ribavirin

51
Q

What does sAg mean?

A

Active infection

52
Q

What does eAg mean?

A

Highly infections, high risk of CLD, HCC, highly infectious

Indicates viral réplication

53
Q

What is is used in Hep Vaccines?

A

sAg

54
Q

What does cAb mean?

A

Previous infection

55
Q

What does HBV DNA?

A

Viral load

56
Q

In assessing Ascites via a diagnostic tap, what can you look for?

A

Cell count - > 500WBC/cm3 >250 neutrophils

Serum ascites albumin gradient - Sr MINUS ascites albumin. (high SAAG) LOW protein ascites >11g/L - portal hypertension

57
Q

What symptoms might lead you to believe a patient has acute pancreatitis?

A

Constant epigastric pain that may radiate to the back
Relieved when leaning forward
Guarding of the abdomen

58
Q

List some types of pancreatic cysts.

A

Intraductal papillary mutinous neoplasm - in continuity with the main pancreatic duct, dysplastic papillary lining secreting mucin
Mucinous cystic neoplasm - ‘ovarian type stroma’
Serous cyst adenoma - no mucin, almost always benign

59
Q

What are some causes of acute cholestasis?

A

Hep A and E
Drug induced
Extrahepatic biliary obstruction

60
Q

What are some causes of Chronic hepatitis?

A

Hep B and C (D)
Genetic depositions - Wilsons, haemochromatosis
AI

61
Q

How could you grade mental state in encephalopathy?

A

Conns score (west haven classification)

Third year (15 decks)

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