MSRA > GI > Flashcards

GI Flashcards

(112 cards)

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1
Q

Age intussusception usually occurs

A

6 - 18 months

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2
Q

Allergy to what other medications may cause allergic reaction to sulfasalazine and mesalazine (5-aminosalicylic acids)

A

aspirin

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3
Q

sulfasaline cations

A

asprin allergy
G6PD deficiency

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4
Q

Is sulfasalazine safe in preganancy and breastfeeding

A

yes

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5
Q

sulfasalzine side effects

A

oligospermia
Stevens-Johnson syndrome
pneumonitis / lung fibrosis
myelosuppression, Heinz body anaemia, megaloblastic anaemia
may colour tears → stained contact lenses

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6
Q

Viral hepatitis

A

Common symptoms: nausea, vomiting, anorexia, myalgia, lethargy, right upper quadrant (RUQ) pain. Risk factors: foreign travel, intravenous drug use.

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7
Q

Congestive hepatomegaly

A

Liver pain occurs if stretched, often due to congestive heart failure. Severe cases can progress to cirrhosis.

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8
Q

Biliary colic

A

RUQ pain, intermittent, begins abruptly and subsides gradually, often postprandial. Nausea common. Classically: female, forties, fat, fair.

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9
Q

Acute cholecystitis

A

Severe, persistent RUQ pain radiating to back or right shoulder. Fever, positive Murphy’s sign (inspiratory arrest on RUQ palpation).

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10
Q

Ascending cholangitis

A

Charcot’s triad: fever (rigors), RUQ pain, jaundice. Often secondary to gallstones.

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11
Q

Gallstone ileus

A

Small bowel obstruction from impacted gallstone. Symptoms: abdominal pain, distension, vomiting. Often from cholecysto-duodenal fistula.

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12
Q

Cholangiocarcinoma

A

Persistent biliary colic, anorexia, jaundice, weight loss. Courvoisier sign (palpable gallbladder), Sister Mary Joseph and Virchow nodes possible.

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13
Q

Acute pancreatitis

A

Severe epigastric pain, vomiting, tenderness, ileus, low-grade fever. Rare signs: Cullen’s (periumbilical) and Grey-Turner (flank) discolouration.

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14
Q

Pancreatic cancer

A

Classically painless jaundice, but pain is common. Also anorexia and weight loss.

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15
Q

Amoebic liver abscess

A

Malaise, anorexia, weight loss, mild RUQ pain, jaundice uncommon.

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16
Q

What is now the most common type of oesophageal cancer in the UK/US?

A

Adenocarcinoma

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17
Q

Where are oesophageal adenocarcinomas most commonly located?

A

Lower third of oesophagus near the gastroesophageal junction

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18
Q

Where are squamous cell oesophageal carcinomas most commonly located?

A

Upper two-thirds of the oesophagus

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19
Q

List key risk factors for oesophageal adenocarcinoma.

A

GORD, Barrett’s oesophagus, smoking, obesity

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20
Q

List key risk factors for oesophageal squamous cell carcinoma.

A

Smoking, alcohol, achalasia, Plummer-Vinson syndrome, nitrosamine-rich diet

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21
Q

What is the most common presenting symptom of oesophageal cancer?

A

Dysphagia

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22
Q

Which symptom suggests advanced upper oesophageal cancer with local invasion?

A

Hoarseness (recurrent laryngeal nerve involvement)

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23
Q

Which investigation is used for diagnosing oesophageal cancer?

A

Upper GI endoscopy with biopsy

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24
Q

What is the preferred method for locoregional staging of oesophageal cancer?

A

Endoscopic ultrasound

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25
Which imaging modality is used for initial staging of oesophageal cancer?
CT chest, abdomen, and pelvis
26
Which scan is used to detect occult metastases in oesophageal cancer?
FDG-PET CT
27
What surgical procedure is commonly performed for operable oesophageal cancer (T1N0M0)?
Ivor-Lewis oesophagectomy
28
What is the major surgical complication after oesophagectomy?
Anastomotic leak causing mediastinitis
29
How is operable oesophageal cancer typically managed?
Surgical resection plus adjuvant chemotherapy
30
What is spontaneous bacterial peritonitis?
A form of peritonitis usually seen in patients with ascites secondary to liver cirrhosis.
31
What are the key features of spontaneous bacterial peritonitis?
Ascites, abdominal pain, and fever.
32
How is spontaneous bacterial peritonitis diagnosed?
Paracentesis showing neutrophil count greater than 250 cells/µL.
33
What is the most common organism found in ascitic fluid cultures in spontaneous bacterial peritonitis?
Escherichia coli.
34
What is the first-line management for spontaneous bacterial peritonitis?
Intravenous cefotaxime.
35
Which patients with ascites should receive antibiotic prophylaxis?
Patients who have had a previous episode of spontaneous bacterial peritonitis, or those with ascitic fluid protein less than 15 g/L and either a Child-Pugh score of at least 9 or hepatorenal syndrome.
36
What antibiotic prophylaxis does NICE recommend for patients with ascites and high risk of spontaneous bacterial peritonitis?
Oral ciprofloxacin or norfloxacin until the ascites resolves.
37
What is a marker of poor prognosis in spontaneous bacterial peritonitis?
Alcoholic liver disease.
38
What is Barrett's oesophagus?
Metaplasia of lower oesophagus: squamous epithelium replaced by columnar epithelium.
39
What is the cancer risk with Barrett's oesophagus?
50-100 fold increased risk of oesophageal adenocarcinoma.
40
How is Barrett's oesophagus usually detected?
During endoscopy for upper GI symptoms like dyspepsia or reflux.
41
How is Barrett's oesophagus classified by length?
Short <3 cm; Long >3 cm (longer = higher risk of metaplasia).
42
Key histological feature of Barrett's oesophagus?
Columnar epithelium resembling gastric or intestinal mucosa (goblet cells).
43
Main risk factors for Barrett's oesophagus?
GORD (strongest), male gender, smoking, central obesity.
44
Is alcohol an independent risk factor for Barrett's?
No, though linked to GORD and oesophageal cancer.
45
Typical symptoms of Barrett's oesophagus?
Often asymptomatic; usually coexistent GORD symptoms.
46
Management of Barrett's oesophagus?
High-dose PPI, endoscopic surveillance every 3-5 yrs if metaplasia.
47
Treatment if dysplasia is found in Barrett's?
Endoscopic therapy: radiofrequency ablation (preferred), mucosal resection.
48
Investigation for intussuception
US TARGET SIGN GOLD STANDARD - CONTRAST ENEMA
49
Intussusception management
Therapeutic enema (air/water/contrast)
50
Histopathology of gastric carcinoma
signet ring cells
51
what is gastric ALT lymphoma assoc with
H Pylori
52
What is zollinger Ellison syndrome
gastric secreting tumour leading to high gastric acid output and peptic ulcers
53
Gold standard diagnostic test for insulinoma
supervised prolonged fast
54
Anti - LKM antibodies
autoimmune hepatitis type 2 Usually affects children and adolescents assoc with other autoimmune diseases
55
Antibodies assoc with autoimmune hepatitis type 1
ANA and anti smoothie muscle antibodies Usually affects adults
56
antibodies assoc with autoimmune hepatitis type 3
anti SLP/LP Rare
57
Associations and antibodies for PBC
anti-mitochondrial antibodies Typically middle aged women with itch and fatigue
58
Associations and antibodies for PSC
UC and less commonly HIV PANCA antibodies
59
Treatment of IBS
1: antispasmodic e.g. mebeverine/hyoscine 2: amitriptyline
60
Treatment of microscopic colitis
If severe budesonide
61
Drugs that cause microscopic colitis
PPI NSAIDs SSRIs Cimetidine
62
Treatment of c diff
Vanc If life threatening vanc and metronidazole Recurrence within 12 weeks fidaxomicin
63
What should be tested prior to azathioprine
Thiopurine methyltransferase TPMT
64
Management of crowns disease
Flare: 1. steroids 2. 5-ASA (mesalazine) Maintenance: 1. azathioprine or mercaptopurine 2. Methotrexate 3.biologics
65
Management of UC
Mild < 4 stools a day Moderate 4-6 Severe >6 mild to moderate flare: Proctitis topical aminosalicylates (e.g. rectal mesalazine) Extensive topical and oral aminosalicylates Add steroid if poor response Severe flare: Admire for IV steroids Add ciclosporin if no response Maintenance: 1. Aminosalicylates 5ASA 2. Consider azathioprine or mercaptopurine
66
Histology of UC
Submucosal inflammation Reduced goblet cells Crypt abscesses
67
Histology of crohns
Cobblestone appearance on endoscopy Transmural inflammation Granulomas Increased goblet cells
68
Side effects of aminosalicylates 5-ASA mesalazine and sulphasalazine
Sulphasalazine: Heinz body anaemia Oligospermia Lung fibrosis Mesalazine Pancreatitis Agranulocytosis
69
Side effects of azathioprine and mercaptopurine
Bone marrow suppression Pancreatitis Increased risk of non melanoma skin cancers
70
What is courvoisers sign
Presence of palpable non tender gallbladder with jaundice indicating malignant obstruction of the common bile duct
71
Cf of peutz Jeghers syndrome
Mutation STK11 (LKBQ) PIGMENTED FRECKLES (LIPS PALMS SOLES) HAMARTOMATOUS POLYPS think with freckles and bowel cancer
72
Cf of cowdens syndrome
PTEN mutation GIT harmartomatous polyps Mucocutaneous lesions (oral papillomas, keratosis) thyroid disease
73
FAP cf
APC gene on chromosome 5 autosomal dominant Hundreds to throw sands of Adenomatous polyps Gardeners syndrome: FAP + Osteomas, cysts, retinal changes
74
Cf of hereditary non-polypodies colorectal cancer (lynch syndrome)
Colon and endometrial cancer Autosomal dominant DNA mismatch repair genes 5% of colorectal cancers
75
PBC antibodies and association
Anti mitochondrial antibodies Assoc with sjogrens
76
PSC assoc and antibodies
Anca UC
77
Gastric MALT lymphoma associations
Strongly associated with hpylori infection Management: h.pylori eradication
78
Gastric cancer biopsy
Signet ring cells on histology
79
Zollinger ellison syndrome and association
Gastric secreting tumour Assoc with men 1
80
Men 1
81
Men 2a
82
Men 2b
83
Cf of chronic pancreatitis
Chronic epigastric pain 15-30 mins post meals radiates to back n+v Endocrine - diabetes Exocrine - steatorrhoea
84
Management of bike acid malabsoprtion
Cholestyramine
85
Treatment of hep b infection
Pegylated IFN alpha
86
HBsAg positive
Surface antigen Current disease
87
Anti-HBs positive
Surface antibody Immunity vaccine or cleared infection
88
Anti HBc positive
Previous or current infection IgM recent IgG past
89
HBeAg positive
Infectivity
90
Management of hep c infection
Direct acting antivirals Daclastir + sofobuvir + ribavirin Sofobuvir + simeprevir + ribavirin
91
Management of hep d
Required hep b surface antigen to replicate Interferon
92
Exam clue pregnant patient with hepatitis and high mortality
Think hep E
93
Anti smoothie muscle antibodies
Type 1 autoimmune hep
94
Anti liver kidney microsomal antibodies
Type 2 autoimmune hep # children
95
Anti solvable antigen/liver pancreas antibodies
Type 3 autoimmune hep
96
Treatment of pbc
Ursodeoxycholic acid
97
Treatment of sbp
Cefotaxime Prophylaxis Oral ciprofloxacin/norfloxacin
98
Diagnosis of sbp
>250 neutrophils
99
IBS treatment
Antispasmodic - mebeverine/hyoscine 2: low dose amitriptyline
100
Psc antibodies
PANCA positive
101
Investigation for bile malabsorption
SeHCAT
102
Polyarteritis nodosa
Mononeuritis multiplex, livedo reticular is,htn, acute renal failure, hep b
103
What is SAAG and what does it tell us
Serum ascites albumin gradient >1.1 portal hypertension <1.1 non portal causes
104
Cea
Raised in colorectal and pancreatic cancers
105
Ca 125
Ovarian cancer
106
Ca 15-3
Breast ca
107
AFP
Hepatocellular and germ cell tumours
108
Ca 19-9
Pancreatic cancer
109
Treatment of anal fissure
Topical lidocaine for pain If symptoms >1week topical gtn
110
How to tell large from small bowel on axr
Large bowel haustra indentation Small bowel valvular conniventes
111
Treatment of diverticulitis
Co-amoxicillin Or metronidazole with cefalexin
112
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