Gastroenterology & Hepatology — Flashcards
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A plain abdominal X ray for Hirschsprungs Disease will demonstrate _____
Gold standard investigation for Hirschprung's disease is _____
Congenital diaphragmatic hernia presents with _____, due to herniation of the abdominal contents into the cleft
Hirschsprung Disease can present with _____ vomiting
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What type of laxative is Movicol Paediatric Plan? _____
Terminal Ileitis (Crohn's) is associated with _____
What is this pathology? _____
_____ is an adverse effect of radiotherapy
Prognostic factors for CDH are: _____
Gastroenterology & Hepatology UK Medical PG Flashcards - Medical Study Cards
Master Gastroenterology & Hepatology with OnCourse flashcards. These spaced repetition flashcards are designed for medical students preparing for NEET PG, USMLE Step 1, USMLE Step 2, MBBS exams, and other medical licensing examinations.
Gastroenterology & Hepatology Flashcard Deck - 893 Cards
Flashcard 1: A plain abdominal X ray for Hirschsprungs Disease will demonstrate _____
Answer: dilated loops of bowel with fluid levels
Flashcard 2: Gold standard investigation for Hirschprung's disease is _____
Answer: Rectal suction biopsy
Flashcard 3: Congenital diaphragmatic hernia presents with _____, due to herniation of the abdominal contents into the cleft
Answer: scaphoid abdomen
Flashcard 4: Hirschsprung Disease can present with _____ vomiting
Answer: bilious
Flashcard 5: bf436201fdd2467bb4524075c13428c5-ao-4
Answer:
Flashcard 6: What type of laxative is Movicol Paediatric Plan? _____
Answer: Osmotic Laxative
Flashcard 7: Terminal Ileitis (Crohn's) is associated with _____
Answer: gallstones
Flashcard 8: What is this pathology? _____
Answer: Congenital Diaphragmatic Hernia
Flashcard 9: _____ is an adverse effect of radiotherapy
Answer: Proctitis
Flashcard 10: Prognostic factors for CDH are: _____
Answer: liver position lung-to head ratio
Flashcard 11: Metoclopramide should not be used for more than _____ due to risk of extrapyradimal effects
Answer: 5 days
Flashcard 12: What are the Red Flags for Constipation in Children: _____ > 48 hours Ribbon Stools' Faltering Growth is an amber flag Previously unkown or undiagnosed weakness in legs, locomoter delay Distension Evidence of Child Maltreatment
Answer: Reported from birth or first few weeks of life
Flashcard 13: What is the Management of Hirschsprung's disease:: _____ surgery to affected segment of the colon
Answer: rectal washouts/bowel irrigation
Flashcard 14: Hirschsprung's disease is 3 times more common in _____
Answer: males
Flashcard 15: Hirschsprung's disease is an important differential diagnosis in _____
Answer: childhood constipation
Flashcard 16: Possible presentation of Hirschsprung's disease in the neonatal period is _____
Answer: failure or delay to pass meconium
Flashcard 17: Hirschsprung's Disease is caused by a _____ due to a developmental failure of the parasympathetic Auerbach and Meissner Plexuses
Answer: aganglionic segement of bowel
Flashcard 18: Hirschsprung's disease is associated with _____
Answer: Down's syndrome
Flashcard 19: Possible presentation of Hirschsprung's disease in older children is _____
Answer: Constipation, abdominal distension
Flashcard 20: What features would suggest faecal impaction in children? _____ Overflow Soiling Faecal Mass Palpable in the Abdomen (DRE should be carried out by specialist
Answer: Symptoms of Severe Constipation
Flashcard 21: Investigations for Hirschsprung's disease consist of _____ and rectal biopsy
Answer: Abdominal x-ray
Flashcard 22: Vast majority of children with consitpation have _____
Answer: no identifiable cause
Flashcard 23: The guidance on management of Constipation in Children if faceal impaction is present consists of: _____ Add a stimulant laxative Substitute a stimulant laxative singly or in combination with osmotive laxative (lactulose) Inform families that disimpaction treatment can initially increase symptoms of soiling and abdo pain
Answer: polyethylene glycol 3350 + electrolytes (Movicol Paediatric Plain)
Flashcard 24: If there are hepatic lesions in with a patient with Hiccups _____ is also used
Answer: dexamethasone
Flashcard 25: The diagnosis of Constipation in Children > 1 year is suggested by 2 or more of the following: Stool Pattern _____ Overflow Soiling (very loose, very smelly, stool passed without sensation) 'Rabbit Droppings' (type 1) Large, infrequent stools that can block the toilet Symptoms associated with defecation Poor appetite that improves with passage of large stool Waxing and waning of abdominal pain with passage of stool Straight-legged, tiptoed, back and arching posture Straining Anal Pain History Previous episodes of constipation Previous or current anal fissures Painful bowel movements and bleeding associated with hard stools
Answer: Fewer than 3 complete stools per week (type 3 or 4)
Flashcard 26: What are Other causes of Constipation in Children? _____ Low-Fibre Diet Medications e.g. Opiates Anal Fissure Over-enthusiastic potty training Hypothyroidism Hirschsprung's Disease Hypercalcaemia Learning Disabilities
Answer: Dehydration
Flashcard 27: _____ and gabapentin are also used in hiccup prescribing in palliative
Answer: Haloperidol
Flashcard 28: What is the monoclonal antibody that targets C.difficile toxin B? _____
Answer: bezlotoxumab
Flashcard 29: Gastrointestinal side-effects of Sodium valproate are _____
Answer: nausea, increased appetite and weight gain
Flashcard 30: What is the test of cure for H.pylori eradication? _____
Answer: There is no need to check for H. pylori eradication if symptoms have resolved following test and treat
Flashcard 31: Managment of Malnutrition involves a _____ rather than prescribing oral nutritional supplements
Answer: food-first approach
Flashcard 32: Before admission to a Care/Nursing Home and Hospital a _____ should be done to screen for malnutrition
Answer: MUST
Flashcard 33: The main medication used in treatment of intractable hiccups is _____
Answer: chloropromazine
Flashcard 34: Sodium valproate can cause _____ and pancreatitis
Answer: hepatotoxicity
Flashcard 35: If ONS are used in malnutrition management they should be _____ rather than instead of meals
Answer: taken between meals
Flashcard 36: NICE describes malnutrition as: _____ or unintentional weight loss greater than 10% within last 3-6 months or a BMI > 20 and unintentional weight loss greater than 5% within last 3-6 months
Answer: a BMI of <18.5
Flashcard 37: An elderly, thin patient with pressure sores should be screened using _____
Answer: MUST
Flashcard 38: The MUST score categorised patients into _____
Answer: low, medium and high risk
Flashcard 39: What is the final-line management of GORD (acid reflux)? _____
Answer: Laparoscopic fundoplication
Flashcard 40: GORD is typically worse after _____ and lying flat
Answer: large meals
Flashcard 41: Barrett's oesophagus is a precursor for _____
Answer: adenocarcinoma
Flashcard 42: The biggest risk factor for GORD is _____ because of the displacement of the lower oesophageal sphincter
Answer: hiatus hernia (sliding sub-type)
Flashcard 43: _____ is premalignant metaplasia of the lower oesophagus arising from chronic acid reflux
Answer: Barrett's oesphagus
Flashcard 44: The surveillance for long-segment > 3cm Barrett's oesophagus is endoscopy every _____
Answer: 2-3 years
Flashcard 45: _____ is a chronic disorder in which pathological retrograde flow of gastric contents into the oesophagus leads to mucosal injury
Answer: Gastro-oesophageal reflux disease (GORD)
Flashcard 46: GORD (acid reflux) symptoms can be rapidly relieved with over the counter _____ but long-term use is NOT recommended
Answer: antacids
Flashcard 47: Barrett's oesophagus is the replacement of _____ with columnar epithelium
Answer: stratified squamous epithelium
Flashcard 48: What is the symptomatic management of Barrett's oesphagus? _____
Answer: Full dose PPI
Flashcard 49: GORD presents with _____ burning pain, regurgitation (acid taste), and a chronic cough worse at night
Answer: retrosternal
Flashcard 50: What is the management of GORD (uninvestigated 'reflux-like' symptoms)? _____
Answer: Full dose PPI for 4 or 8 weeks
Flashcard 51: GORD is caused by gastroesophageal junction incompetence from ↓ _____ tone and ↑ intra-abdominal pressure
Answer: LES
Flashcard 52: Barrett's oesophagus is proximal extension of the _____ junction (Z-line) into the distal oesophageal mucosa
Answer: squamocolumnar
Flashcard 53: What is the management for Barrett's oeosphagus WITH high-grade dysplasia? _____
Answer: Offer endoscopic resection
Flashcard 54: What is the investigation for GORD (acid reflux) if further investigations are needed? _____
Answer: Oesophago-gastroduodenoscopy
Flashcard 55: The surveillance for short-segment < 3cm Barrett's oesophagus is endoscopy every _____
Answer: 3-5 years
Flashcard 56: Barrett's oesophagus is typically an _____ diagnosis when undergoing endoscopy for another indication
Answer: incidental
Flashcard 57: Short-segment Barrett's oesophagus is < _____ cm Long-segment Barrett's oesophagus is > 3 cm
Answer: 3
Flashcard 58: What is the pharmacological management of GORD unresponsive to PPI? _____
Answer: H2RA therapy
Flashcard 59: What is the likely diagnosis in a middle-age patient presents with burning chest pain and a chronic non-productive cough unrelated to activity. He has a BMI of 34 kg/m2 with normal cardiac & respiratory examination. _____
Answer: Gastroesophageal reflux disease (GORD)
Flashcard 60: Dyspepsia is defined as chronic or recurren pain/discomfort in the _____ often described as "indigestion"
Answer: upper abdomen
Flashcard 61: What are adverse effects of Nicorandil?
Answer: • May cause ulceration anywhere in the GI tract
Flashcard 62: What medication is associated with high risk of C.difficile?
Answer: • Clindamycin
Flashcard 63: What is used to determine severity in C.Diff infection?
Answer: • White cell count
Flashcard 64: What is the most sensitive and specific lab finding for diagnosis of liver cirrhosis in those with chronic liver disease?
Answer: • Thrombocytopenia (low platelet count)
Flashcard 65: What is the definitive management in variceal haemorrhage?
Answer: • Endoscopic variceal band ligation
Flashcard 66: What is the first-line medication for primary biliary cholangitis?
Answer: • Ursodeoxycholic acid
Flashcard 67: What is the first-line treatment in mild-moderate flare of distal ulcerative colitis?
Answer: • Rectal Aminosalicylates
Flashcard 68: What will you find on LFTs in alcoholic hepatitis?
Answer: • AST/ALT ratio = 2:1
Flashcard 69: What score is used to determine the severity of a GI bleed, and whether or not the patient needs admitting?
Answer: • Blatchford score
Flashcard 70: • What should be administered to patients before variceal band ligation?
Answer: • IV Terlipressin • Prophylactic antibiotics
Flashcard 71: In extensive disease of UC where rectal aminosalicylates are not sufficient, what should be added?
Answer: • Oral Aminosalicylates
Flashcard 72: What can reduce mortality in cirrhotic patients with GI bleeding?
Answer: • Antibiotic prophylaxis
Flashcard 73: What is the preferred diuretic in ascites secondary to liver cirrhosis?
Answer: • Aldosterone antagonist (spironolactone)
Flashcard 74: What type of acid-base disturbance does diarrhoea cause?
Answer: Normal anion gap metabolic acidosis
Flashcard 75: How are Liver Abscesses generally managed?
Answer: • Antibiotics & Drainage
Flashcard 76: What is Acute Mesenteric Ischaemia typically caused by, and what do patients classically have in their history?
Answer: • Typically caused by an embolism resulting in occlusion of an artery which supplies the small bowel • Classically patients have a Hx of Atrial Fibrillation
Flashcard 77: What would cause pain when, or shortly after, eating?
Answer: • Gastric Ulcer
Flashcard 78: What is IgM anti-HBc positive in?
Answer: • Apprears in Acute or recent Hep B infection, present for about 6 months
Flashcard 79: What is Haematochezia?
Answer: • Passage of fresh blood from the rectum, often occurs with lower GI bleeding
Flashcard 80: What can Coeliac Disease show on FBC?
Answer: • Normocytic Anaemia • Coeliac impairs the absorption of several vitamins and minerals, incl: iron & vit B12
Flashcard 81: What else can differentiate an Upper GI bleed verses a lower GI bleed, other than melaena?
Answer: • High urea levels
Flashcard 82: When is Oral Vancomycin with IV metronidazole given in C.Diff?
Answer: • When it is a life-threatening infection. Confirmed C.Diff with hypotension, partial/complete ileus, toxic megacolon
Flashcard 83: What type of oesophageal cancers are associated with GORD or Barret's disease?
Answer: • Adenocarcinoma
Flashcard 84: What is Diversion Colitis?
Answer: • A condition in which a person's colon becomes inflamed following ostomy surgery
Flashcard 85: What is an adenocarcinoma?
Answer: • Type of cancer that originates in the glandular cells • which line organs and secrete substances like mucus (secretory)
Flashcard 86: What type of antibiotics can influence the risk of C.Diff infection?
Answer: • Second and third-generation cephalosporins cefuroxime
Flashcard 87: What gene is associated with HNPCC (Hereditary Non-Polyposis Colorectal carcinoma)
Answer: MSH2 gene
Flashcard 88: What does Courvoisier's law state that in the presence of painless obstructive jaundice...
Answer: • A palpable gallbladder in unlikely to be due to gallstones
Flashcard 89: If HBsAg is positive and Anti-HBc is positive what is the interpretation?
Answer: • Chronic hepatitis B infection Positive HBsAg is are marker of infection, acute or chronic
Flashcard 90: What is the investigation of choice for suspected perianal fistulae in patients with Crohn's?
Answer: • MRI pelvis
Flashcard 91: What is an isolated rise in bilirubin in response to physiological stress is typical of?
Answer: Gilbert's Syndrome
Flashcard 92: What is Dyspepsia?
Answer: A collection of symptoms: - Epigastric Pain - Bloating - Nausea - Regurgitiation - Heartburn
Flashcard 93: What is migratory thrombophelbitis (Trousseau's Syndrome) seen more commonly in?
Answer: Pancreatic Cancer
Flashcard 94: What cancer does Pernicious anaemia (PA) predispose?
Answer: • Gastric carcinoma
Flashcard 95: Patients with HNPCC are also at higher risk of what other types of cancer?
Answer: • Endometrial cancer
Flashcard 96: What GI condition is associated with pigmented freckles on the lips, face, palms and sole?
Answer: • Peutz-Jegher's Syndrome
Flashcard 97: What is halitosis?
Answer: • Bad breath
Flashcard 98: Prolonged vomiting/NG tube suctioning: Acid-Base Abnormality: _____ Cl-: ↓ K+: ↓
Answer: Metabolic alkalosis
Flashcard 99: 'double duct' sign—dilation of both the common bile duct and the pancreatic duct is seen in?
Answer: Pancreatic Cancer
Flashcard 100: What medication is used first-line to maintain remission in patients with Chron's?
Answer: • Azathioprine Mercaptopurine
Flashcard 101: A severe flare of ulcerative colitis should be...
Answer: treated in hospital with IV corticosteroids
Flashcard 102: What is usually used to induce remission in Chron's disease?
Answer: • Glucocorticosteroids (Prednisone)
Flashcard 103: What is the managment in life-threatening C.Diff?
Answer: • Oral vancomycin + IV metronidazole
Flashcard 104: What is the most common cause of liver disease in the developed world?
Answer: • Non-alcoholic fatty liver disease (NAFLD)
Flashcard 105: Which part of the colon is most likely affected in Ischaemic colitis?
Answer: • Splenic flexure
Flashcard 106: Primary Sclerosing Cholangitis is most associated with?
Answer: • Ulcerative Colitis (UC)
Flashcard 107: What happens to serum caeruloplasmin in Wilson's disease?
Answer: • Decreased
Flashcard 108: What is Odynophagia?
Answer: • Painfuk swallowing
Flashcard 109: What is the gold-standard investigation for Oesophageal Cancer?
Answer: • Endoscopy
Flashcard 110: What is HNPCC?
Answer: Hereditary non-polyposis colorectal carcinoma
Flashcard 111: What would Anti-HBs Negative indicate?
Answer: • Anti-HBs indicated immunity and is therefore negative in acute infection
Flashcard 112: Small bowel obstruction (often due to intussusception) is a common presenting complaint in?
Answer: Peutz-Jegher's Syndrome
Flashcard 113: What is Intussusception?
Answer: • Segement of intestine telescopes into an adjacent segement
Flashcard 114: What Acid-Base disturbance will Vomiting cause?
Answer: • Metabolic alkalosis
Flashcard 115: Patient presents with flushing, diarrhoea, abdominal pain and weight loss, with a systolic murmur and hepatomegaly, Diagnosis?
Answer: • Carcinoid Syndrome When metastases are present in the liver and release seratonin into systemic circulation
Flashcard 116: You wish to screen a patient for hepatitis B infection. Which one of the following is the most suitable test to perform?
Answer: HBsAg
Flashcard 117: T2DM with abnormal LFTs?
Answer: • NAFD (non-alcoholic fatty liver disease)
Flashcard 118: Severe UC classification?
Answer: • > 6 bowel movements per day
Flashcard 119: Serum caeruloplasmin in Wilson's Disease is?
Answer: • decreased
Flashcard 120: What should be suspected in all patients who have diarrhoea shortly following antibiotic therapy?
Answer: • C.Diff Infection
Flashcard 121: What is the reference range for Bilirubin?
Answer: 3-17 umol/l
Flashcard 122: Severe diarrhoea/laxtive use: Acid-Base Abnormality: _____ Cl-: ↑ K+: ↓
Answer: Metabolic acidosis
Flashcard 123: What is the diagnosis of yellow discolouration and dark rings around the iris of both eyes?
Answer: Kayser-Fleischer rings are seen in the eyes of patients with Wilson's disease
Flashcard 124: What is the first-line treatment for someone with Wilson's disease?
Answer: • Penicillamine
Flashcard 125: What can develop in around 10% of primary sclerosing cholangitis patients?
Answer: • Cholangiocarcinoma
Flashcard 126: Membranous nephropathy is associated with _____
Answer: hepatitis B
Flashcard 127: _____ presents with bloody diarrhoea, abdominal pain, RUQ pain & fever
Answer: Amoebic liver abscess
Flashcard 128: Norovirus high ↑ virulence is associated with _____
Answer: rapid outbreaks (nursing homes, hospital wards, cruise ships, daycare)
Flashcard 129: Amoebiasis is investigated with _____
Answer: stool PCR
Flashcard 130: What is the What is the most common viral gastroenteritis in unvaccinated children? _____
Answer: Rotavirus
Flashcard 131: _____ is a highly contagious RNA virus in the Reoviridae family causing severe watery diarrhoea, vomiting, & dehydration
Answer: Rotavirus
Flashcard 132: The _____ vaccine is associated with intussusception
Answer: rotavirus
Flashcard 133: Norovirus is a clinical diagnosis but can be investigated with _____
Answer: stool PCR
Flashcard 134: What is a complication of rotavirus diarrhoea? _____
Answer: Dehydration
Flashcard 135: Amoebic liver abscesses may also require _____ alongside the mainstay management
Answer: drainage
Flashcard 136: Norovirus presents with _____ alongside vomiting and pyrexia
Answer: watery diarrhoea
Flashcard 137: _____ consumption is associated with norovirus
Answer: Raw shellfish
Flashcard 138: Amoebic liver abscess is investigated with _____ that identifies a(n) hypoecholic lesion
Answer: US
Flashcard 139: Entamoeba histolytica is transmitted via the _____ route in endemic areas
Answer: faecal-oral
Flashcard 140: _____ is a highly contagious RNA virus in the Caliciviridae family that causes acute gastroenteritis
Answer: Norovirus
Flashcard 141: What is the most common viral gastroenteritis in vaccinated children? _____
Answer: Norovirus
Flashcard 142: Rotavirus is a clinical diagnosis but can be investigated with _____
Answer: stool rotavirus antigen test (ELISA)
Flashcard 143: What is the management of norovirus? _____
Answer: Supportive (manage for dehydration with fluids & electrolyte replacement; antiemetics)
Flashcard 144: Viral gastroenteritis are spread through the _____ route
Answer: faecal-oral
Flashcard 145: What is the management of amoebiasis? 1. _____ 2. followed by a(n) "luminal agent" (e.g. paromomycin) to prevent reinfection & transmission by eliminating intraluminal cysts present in the intestinal lumen
Answer: metronidazole or tinidazole
Flashcard 146: Norovirus & rotavirus typically occur in the _____ season
Answer: winter
Flashcard 147: What is the most common viral gastroenteritis in adults? _____
Answer: Norovirus
Flashcard 148: Entamoeba histolytica (amoebiasis) presents with _____ & abdominal pain
Answer: bloody diarrhoea
Flashcard 149: Entamoeba histolytica can cause an amoebic liver abscess which have a(n) "_____" consistency
Answer: anchovy paste
Flashcard 150: Rotavirus presents with _____ alongside vomiting and pyrexia
Answer: severe watery diarrhoea
Flashcard 151: _____ & rotavirus are the most common viral gastroenteritis
Answer: Norovirus
Flashcard 152: What complication can occur in norovirus & rotavirus? _____
Answer: Dehydration → assess fluid status (mucous membranes, capilliary refill, BP, HR, U&Es, urine output)
Flashcard 153: _____ is a viral gastroenteritis associated with prolonged water diarrhoea, vomiting, & fever typically in young children
Answer: Enteric adenovirus
Flashcard 154: Patients with norovirus should exclude themself from social contact for _____
Answer: 48hrs until after resolution
Flashcard 155: What is the management of rotavirus? _____
Answer: Supportive (manage for dehydration with fluids & electrolyte replacement; antiemetics)
Flashcard 156: What is the management of cryptosporidiosis in HIV patients? _____ If needed, nitazoxanide can be added
Answer: Anti-retroviral therapy to increase CD4+ count > 100 cells/mm3
Flashcard 157: _____ causes slow-onset diarrhoea caused by spore ingestion from reheated meats
Answer: Clostridium perfringens
Flashcard 158: What is the likely cause of chronic watery diarrhoea in a HIV patient with a CD4+ count of 92/mm3 and abdomnial cramps with a low-grade fever? _____
Answer: Cryptosporidiosis
Flashcard 159: Salmonella (non-typhoidal) is self-limiting but can be treated with _____ in severe cases
Answer: fluoroquinolones
Flashcard 160: Which microorganism that causes watery diarrhoea is most associated with travelling? _____
Answer: Enterotoxigenic E. coli (ETEC)
Flashcard 161: Giardiasis Initial investigation: _____ Gold-standard: PCR
Answer: stool microscopy (ova, cysts & parasites OC&P)
Flashcard 162: Enterotoxigenic E. coli (ETEC) is transmitted by contaminated _____ sources
Answer: water/food
Flashcard 163: _____ is a protozoal infection caused by Cryptosporidium spp. leading to watery diarrhoea, dehydration, & abdominal cramps
Answer: Cryptosporidiosis
Flashcard 164: Vibrio cholerae is acquired from _____
Answer: contaminated drinking water
Flashcard 165: _____, foul-smelling chronic diarrhoea in giardiasis is caused by fat malabsorption
Answer: Floating
Flashcard 166: Staphylococcus aureus & Bacillus cereus (emetic type) gastroenteritis is caused by _____ toxins that have a rapid-onset (<6hr)
Answer: preformed
Flashcard 167: _____ is a protozoa (parasite) that causes chronic watery diarrhea in immunocompromised patients
Answer: Cryptosporidium
Flashcard 168: Shigella and Enterohemorrhagic E. coli (EHEC) both produce _____ toxins that result in bloody diarrhea and can cause haemolytic uraemic syndrome
Answer: shiga
Flashcard 169: Acute diarrhoea associated with undercooked chicken implicates _____ & Shigella
Answer: Salmonella (non-typhoidal)
Flashcard 170: _____ presents with "rice-water" stools ± low-grade fever
Answer: Vibrio cholerae
Flashcard 171: Which microorganism causes acute bloody diarrhoea acquired from raw chicken, eggs, or poultry? _____
Answer: Salmonella (non-typhoidal)
Flashcard 172: What is the most common bacterial gastroenteritis? _____
Answer: Campylobacter jejuni
Flashcard 173: _____ is a protozoal infection caused by Giardia duodenalis leading to chronic, foul-smelling diarrhoea & bloating
Answer: Giardiasis
Flashcard 174: What is the likely cause of fatty, foul-smelling diarrhoea, bloating, & abdominal pain in a patient with recent travel to thailand? _____
Answer: Giardiasis
Flashcard 175: Giardia is typically ingested from _____ associated with travel/camping/hiking
Answer: contaminted drinking water (unfiltered)
Flashcard 176: Enterohaemorrhagic E. coli is transmitted by eating _____
Answer: undercooked beef
Flashcard 177: Which microorganism is associated with sudden-onset vomiting** & abdominal pain after studying all day for the UKMLA and eating leftover Chinese food? _____
Answer: Bacillus cereus
Flashcard 178: Cryptosporidiosis is transmitted via the _____ route
Answer: faecal-oral
Flashcard 179: Vibrio cholerae can lead to fatal _____
Answer: dehydration → urgent fluids may be necessary if severe
Flashcard 180: _____ is a protozoal infection caused by Entamoeba histolytica leading to bloody diarrhoea & potential extraintestinal manifestations
Answer: Amoebiasis
Flashcard 181: Campylobacter jejuni is self-limiting but can be treated with _____ in severe cases
Answer: macrolides (e.g. azithromycin)
Flashcard 182: Which microorganism is associated with sudden-onset food poisoning with predominant vomiting after eating dairy products? _____
Answer: Staphylococcus aureus
Flashcard 183: Cryptosporidiosis in HIV+ patients typically occurs at CD4+ counts < _____ cells/mm3
Answer: 100
Flashcard 184: Enterotoxigenic E. coli = _____ diarrhoea Enterohaemorrhagic E. coli = Bloody diarrhoea
Answer: Watery
Flashcard 185: What are the two bacteria that cause rapid-onset (<6hr) food poisoning with vomiting? _____ and bacillus cereus (emetic syndrome)
Answer: Staphylococcus aureus
Flashcard 186: Antibiotics _____ indicated in enterohaemorrhagic E. coli (EHEC) because of ↑ increased risk of haemolytic uraemic syndrome
Answer: are NOT
Flashcard 187: What microorganism is associated with children causing rapid-onset high fever, bloody diarrhoea ± seizures? _____
Answer: Shigella
Flashcard 188: _____ initially presents with watery & ill-smelling diarrhoea followed by bloody diarrhea
Answer: Campylobacter jejuni
Flashcard 189: Giardiasis is managed with _____
Answer: metronidazole
Flashcard 190: Bacillus cereus gastroenteritis is predominantly associted with _____
Answer: reheated rice
Flashcard 191: Cryptosporidiosis is diagnosed from _____ with acid-fast (Ziel-Neelsen) stain displaying red oocysts
Answer: stool microscopy
Flashcard 192: The most common bacteria implicated in peritonitis is _____
Answer: Escherichia coli
Flashcard 193: Once a diagnosis of gastric cancer is made via endoscopy, _____ is used to help with TNM staging and CT TAP is used to confirm the patient is a surgical candidate (rule out distant metastases)
Answer: endoscopic ultrasound
Flashcard 194: Offer an urgent upper GI _____ to assess for gastric cancer in patients with dysphagia or ≥ 55 years old with weight loss and upper abdominal pain, reflux, or dyspepsia
Answer: endoscopy
Flashcard 195: Gastric cancer may spread to the _____ region known as a(n) Sister Mary Joseph nodule
Answer: periumbilical
Flashcard 196: Helicobacter pylori increases ↑ the risk of developing _____ & gastric MALT lymphoma
Answer: gastric adenocarcinoma
Flashcard 197: Auscultation of a peritonitic abdomen may reveal _____
Answer: decreased/absent bowel sounds
Flashcard 198: Peritonitis presents with _____, diffuse abdominal pain with a(n) fever
Answer: severe
Flashcard 199: Inspection of a peritonitic abdomen may reveal _____ with the patient motionless & knees flexed
Answer: abominal distension
Flashcard 200: What is the management for resectable/localised gastric cancer? _____
Answer: Surgical
Flashcard 201: Consider non-urgent upper GI endoscopy to assess for stomach cancer in patients with _____
Answer: haematemesis
Flashcard 202: _____ is inflammation of the peritoneum
Answer: Peritonitis
Flashcard 203: Consider the suspected cancer pathway referral for people with an _____ consistent with stomach cancer
Answer: upper abdominal mass
Flashcard 204: What is the investigation for a peritonitic abdomen? _____ CT Peritoneal fluid analysis
Answer: FBC, blood cultures, VBG
Flashcard 205: _____ cancer rarely can present with Leser-Trélat sign, which is sudden-onset of multiple seborrheic keratoses
Answer: Gastric
Flashcard 206: What is the initial investigation for gastric cancer? _____
Answer: Upper GI endoscopy with biopsy
Flashcard 207: Gastric cancer more commonly affects _____ 2:1
Answer: males
Flashcard 208: _____ peritonitis is caused by contamination of the peritoneal cavity from a a ruptured viscus or intra-abdominal pathology
Answer: Secondary
Flashcard 209: Gastric cancer may spread to the _____ lymph node known as Virchow's node
Answer: left supraclavicular
Flashcard 210: A Japanese patient with epigastric pain, weight loss, ↓ appetitie, & iron deficiency anaemia, what is the most likely diagnosis? _____
Answer: Gastric cancer
Flashcard 211: A diet with ↑ _____ in smoked meats is associated with gastric cancer (particularly seen in Japan)
Answer: nitrates
Flashcard 212: What is the management for a peritonitic abdomen? _____ Surgical intervetion → typically urgent explorative laparotomy
Answer: Empirical antibiotics (e.g. piperacillin & tazobactam)
Flashcard 213: Primary peritonitis is without an identifiable cause, often assciated with _____ & peritoneal dialysis-associated peritonitis
Answer: spontaneous bacterial peritonitis
Flashcard 214: Gastric cancer can present nonspecifically in _____ stages with mild dyspepsia, epigastric discomfort, & ↓ appetitie
Answer: earlier
Flashcard 215: _____ tumour is a metastatic mucinous tumour of BOTH ovaries most commonly secondary to gastric cancer
Answer: Krukenberg
Flashcard 216: The most common fungal organism implicated in peritonitis is _____ in tertiary / immunocomprimised patients
Answer: Candida spp.
Flashcard 217: Chermotherapy / radiotherapy in gastric cancer can be used in a _____, adjuvant, & palliative setting
Answer: neoadjuvant
Flashcard 218: Gastric cancer can present in _____ stages with epigastric pain, unintentional weight loss, IDA, dysphagia, N&V, hematemesis, melena
Answer: later
Flashcard 219: Gastric cancer can rarely present with hyperpigmented, velvety plaques of the neck & axilla known as _____
Answer: acanthosis nigricans
Flashcard 220: ~90% of gastric cancers are _____
Answer: adenocarcinomas
Flashcard 221: Palpation of a peritonitic abdomen may reveal _____, guarding and rebound tenderness
Answer: rigidity
Flashcard 222: The strongest risk factor for gastric cancer is _____
Answer: Helicobacter pylori infection
Flashcard 223: What is the management for unresectable/metastatic gastric cancer? _____
Answer: Chemotherapy or radiotherapy options
Flashcard 224: _____ is a malignant tumour arising from the stomach lining
Answer: Gastric cancer
Flashcard 225: What is the management for HER2+ve metastatic gastric cancer? _____
Answer: Trastuzumab (Herceptin)
Flashcard 226: _____ peritonitis is persistent or recurrent peritonitis following treatment of primary or secondary peritonitis, often involving resistant or opportunistic organisms in critically ill or immunosuppressed patients
Answer: Tertiary
Flashcard 227: A diet with ↑ _____ increases the carcinogenic effects of Helicobacter pylori
Answer: salts
Flashcard 228: What are modifiable risk factors for gastric adenocarcinoma? _____
Answer: Smoking & alcohol
Flashcard 229: What are the common causes of GI perforation? • _____ • Infection (e.g. appendicitis, diverticulitis) • Trauma (e.g. iatogenic, stabbing) • Ulcerative disease (e.g. peptic ulcer disease, IBD)
Answer: Bowel ischaemia (e.g. mesenteric ischaemia, obstruction)
Flashcard 230: Palpation of a peritonitic abdomen may reveal _____, guarding and rebound tenderness
Answer: rigidity
Flashcard 231: Past history of _____ and LLQ pain is suggestive of perforated diverticulitis
Answer: constipation
Flashcard 232: Peptic ulcers on the _____ duodenal wall are more likely to perforate
Answer: anterior
Flashcard 233: _____ is the most common cause of perforation peritonitis
Answer: Peptic ulcer disease
Flashcard 234: _____ is a congenital abnormality of the bowel that can rarely cause peritonitis due to perforation
Answer: Meckel's diverticulum
Flashcard 235: Suspected GI perforation with localised _____ pain is suggestive of contained perforated appendicitis
Answer: RLQ
Flashcard 236: What is the management for most GI perforations? _____
Answer: Urgent explorative laparotomy
Flashcard 237: Stab injury and blunt abdominal trauma are examples of _____ GI perforation
Answer: traumatic
Flashcard 238: _____ may be used as an alternative to CT for suspected GI perforation in patients where radiation exposure is contraindicated (e.g. pregnancy)
Answer: Abdominal ultrasound
Flashcard 239: Suspected GI perforation with localised _____ pain is suggestive of contained perforated diverticulitis
Answer: LLQ
Flashcard 240: _____ presents with sudden-onset of severe, diffuse abdominal pain with peritonitis
Answer: Gastrointestinal perforation
Flashcard 241: Gastrointestinal malignancies may cause a _____ due to erosion of surrounding tissue
Answer: perforation
Flashcard 242: Acute mesenteric ischaemia and bowel obstruction are examples of _____ GI perforation
Answer: ischaemic
Flashcard 243: Auscultation of a peritonitic abdomen may reveal _____
Answer: decreased/absent bowel sounds
Flashcard 244: Extraluminal gas (pneumoperitoneum) & Loss of bowel wall continuity upon CT abdomen are suggestive of _____
Answer: GI perforation
Flashcard 245: Conservative management for GI perforation involves _____ and broad spectrum antibiotics
Answer: bowel rest (nil by mouth & maintenance fluids)
Flashcard 246: Pain radiating to the _____ is suggestive of an upper GI perforation
Answer: shoulder
Flashcard 247: What is the first-line investigation for suspected GI perforation? _____
Answer: CT (TAP)
Flashcard 248: Appendicitis and diverticulitis are examples of _____ GI perforation
Answer: infective
Flashcard 249: _____ may be used as an initial investigation for an 'acute abodomen'. However, CT (TAP) is the first-line investigation for suspected GI perforation?
Answer: Erect CXR
Flashcard 250: Peptic ulcer disease and IBD are examples of _____ GI perforation
Answer: ulcerative
Flashcard 251: Inspection of a peritonitic abdomen may reveal _____
Answer: abominal distension
Flashcard 252: What is the management of a well-contained GI perforation with no signs of _____ or peritonitis? Conservative management (Bowel rest, Abx, monitoring of vital signs, serial abdo exams)
Answer: sepsis
Flashcard 253: What are the characteristic findings upon CT of GI perforation? _____ & Loss of bowel wall continuity
Answer: Extraluminal free gas (pneumoperitoneum)
Flashcard 254: Iron is absored in the _____ in the Fe2+ (ferrous) state
Answer: duodenum
Flashcard 255: _____ transplantation may be required in people with homozygous familial hypercholesterolaemia
Answer: Liver
Flashcard 256: Rule out _____ in men or postmenopausal women with iron deficiency anaemia
Answer: gastrointestinal bleeding
Flashcard 257: What is the most common cause of iron deficiency in the elderly (Western world)? _____
Answer: Colorectal cancer / colon polyps
Flashcard 258: What is the most common cause of iron deficiency in males aged 20-50? _____
Answer: Peptic ulcer disease
Flashcard 259: Patients older than >60yrs with iron deficiency anaemia should be _____
Answer: offered a FIT test
Flashcard 260: _____lipidaemia is a well known cause of acute pancreatitis
Answer: Hyper
Flashcard 261: What is the most common source of significant intraabdominal bleeding in blunt abdominal trauma? _____
Answer: Ruptured spleen
Flashcard 262: _____ is associated with calcium oxalate kidney stones **bonus, why?
Answer: Crohn's disease
Flashcard 263: Duodenal ulcers located in the _____ duodenum may rupture, leading to bleeding from the gastroduodenal artery
Answer: posterior
Flashcard 264: Folate is absorbed in the _____ and stored in the liver for up to 3 months
Answer: jejunum
Flashcard 265: What is a common cause of death in haemochromatosis? _____
Answer: Hepatocellular carcinoma
Flashcard 266: Haemochromatosis clasically presents with this triad (advanced): _____ Diabetes mellitus Bronze skin
Answer: Cirrhosis
Flashcard 267: Co-prescribe long-term NSAIDs use with _____ to prevent peptic ulcers
Answer: PPI
Flashcard 268: What is the most common ulcer complication (both gastric and duodenal)? _____
Answer: Haemorrhage
Flashcard 269: Screen for haemochromatosis if it is suspected or _____ relatives of hereditary haemochromatosis patients
Answer: first-degree
Flashcard 270: What is the lifestyle management of cirrhosis? _____
Answer: AVOID alcohol!!
Flashcard 271: Before a urea breath test, stool antigen test, CLO test for H. pylori, do NOT take PPIs in the last 2 weeks and antibiotics in the last _____
Answer: 4 weeks
Flashcard 272: Spot diagnosis = _____
Answer: Spider nevus/angiomata
Flashcard 273: Decompensated cirrhosis can lead to life-threatening complications manifesting as _____, hepatic encephalopathy, jaundice, variceal bleeding, & spontaneous bacterial peritonitis (SBP)
Answer: ascites
Flashcard 274: _____ is a temporary obstruction of the cystic duct or common bile duct from a gallstone causing postprandial RUQ pain
Answer: Biliary colic
Flashcard 275: Spot diagnosis = _____
Answer: paralytic ileus; gaseous distension, no transition point
Flashcard 276: Hepatitis _____ is the most common viral hepatic cause of cirrhosis
Answer: C
Flashcard 277: _____ ulcer pain worsens with eating Duodenal ulcer pain improves with eating
Answer: Gastric
Flashcard 278: Ascites is a(n) _____ sign of cirrhosis
Answer: late
Flashcard 279: Spider naevi are a(n) _____ sign of cirrhosis
Answer: early
Flashcard 280: What is the investigation for peptic ulcers? _____
Answer: Carbon-13 urea breath test or stool antigen test
Flashcard 281: What is the management for H. pylori -ve peptic ulcers? _____ for 2 months
Answer: Full dose PPI
Flashcard 282: Peptic ulcers have a median age of diagnosis of _____-50 years
Answer: 20
Flashcard 283: Coagulation profile for acute liver failure will show INR > _____
Answer: 1.5
Flashcard 284: Gynaecomastia & testicular atrophy are a(n) _____ sign of cirrhosis
Answer: late
Flashcard 285: What is the definitive management for acute liver failure? _____
Answer: Liver transplant
Flashcard 286: Jaundice is a(n) _____ sign of cirrhosis and is commonly accompanied by pruritis
Answer: intermediate
Flashcard 287: _____ are ulcerative lesions often distinguished by gastric ulcers & duodenal ulcers
Answer: Peptic ulcers
Flashcard 288: The triad of acute liver failure is: - _____ - Coagulopathy ± Jaundice
Answer: Encephalopathy (AMS, asterixis)
Flashcard 289: Biliary colic typically present with _____ RUQ abdominal pain that may radiate to the right shoulder and occurs after a(n) meal (particularly fatty)
Answer: colicky
Flashcard 290: Hepatitis _____ & B are the most common viral hepatitis to cause acute liver failure
Answer: A
Flashcard 291: Portal hypertension may lead to _____ shunts, which can result in oesophageal varices, gastric varices, anorectal varices, and caput medusae
Answer: portosystemic
Flashcard 292: Caput medusae is a(n) _____ sign of cirrhosis
Answer: late
Flashcard 293: Paralytic ileus presents with _____ & reduced/absent gas
Answer: constipation
Flashcard 294: The most common causes of acute liver failure: Idiopathic 20-45% cases _____ Paracetamol toxicity
Answer: Viral hepatitis (A & B>)
Flashcard 295: How is hepatic encephalopathy managed? First-line: _____ Secondary prophylaxis: rifaximin
Answer: lactulose
Flashcard 296: Paralytic ileus is a clinical diagnosis, but _____ is often done to rule out other causes
Answer: abdominal x-ray
Flashcard 297: If a patient is allergic to penicllin, what is given for H. pylori eradication therapy? _____
Answer: - PPI - Metronidazole** - Clarithromycin
Flashcard 298: Acute liver failure can also present with _____ abdominal pain
Answer: RUQ
Flashcard 299: The liver damage in alcoholic cirrhosis is mediated by _____
Answer: acetaldehyde
Flashcard 300: Asterixis is a(n) _____ sign of cirrhosis
Answer: late
Flashcard 301: Peptic ulcers present with "_____" epigastric pain
Answer: gnawing
Flashcard 302: What is the second-line imaging for biliary colic if US is inconclusive, but the duct is dilated and/or LFTs are abnormal? _____
Answer: MRCP
Flashcard 303: 70% of peptic ulcers present _____
Answer: asymptomatically
Flashcard 304: Peptic ulcers are typically caused by _____ & chronic NSAID use
Answer: H. pylori infection
Flashcard 305: Peptic ulcer disease incidence is _____ in the West because of improved sanitisation
Answer: decreasing
Flashcard 306: Biliary colic presents with _____, sudden-onset RUQ pain that lasts < 6 hours
Answer: severe
Flashcard 307: Compensated (asymptomatic) cirrhosis may present with non-specific signs including fatigue, weight _____ and early clinical signs including spider nevus/naevi
Answer: loss
Flashcard 308: What is the management for biliary colic? _____
Answer: Elective laparascopic cholecystectomy
Flashcard 309: The common causes of cirrhosis in the UK are _____, viral hepatitis, & non-alcoholic fatty liver disease (NAFLD)
Answer: alcoholic cirrhosis
Flashcard 310: Overdose of acetaminophen causes _____ necrosis
Answer: hepatic
Flashcard 311: What is the initial imaging for cirrhosis? _____
Answer: Transient elastography "fibroscan"
Flashcard 312: AST & ALT are ↑ in cirrhosis: ALT _____ AST in early cirrhosis ALT < AST in advanced cirrhosis or alcoholic cirrhosis
Answer: >
Flashcard 313: H. pylori infection cause peptic ulcers, particularly _____ ulcers
Answer: duodenal
Flashcard 314: On abdominal palpation for cirrhosis, _____megaly & hepatomegaly can be felt
Answer: spleno
Flashcard 315: In advanced cirrhosis the _____ is ↑ due to impaired ability of the liver to produce clotting factors
Answer: prothrombin time
Flashcard 316: What is the management for H. pylori +ve peptic ulcers? _____
Answer: Eradication therapy: - PPI - Amoxicillin - Clarithromycin
Flashcard 317: Hepatic encephalopathy is ultimately treated by _____
Answer: liver transplant
Flashcard 318: What is the curative management of cirrhosis? _____
Answer: Liver transplant
Flashcard 319: What is the investigation for peptic ulcers if > 55 or red flag symptoms? _____
Answer: Endoscopy (biopsy is often taken, a CLO test is done on ulcers for H. pylori infection testing)
Flashcard 320: _____ is chronic inflammation of the liver causing scar tissue to replace normal tissue
Answer: Liver cirrhosis
Flashcard 321: _____ cirrhosis describes the initial asymptomatic phase where the liver function is preserved
Answer: Compensated
Flashcard 322: On examination for paralytic ileus there is _____ due to gas accumulation
Answer: abdominal distension
Flashcard 323: Palmar erythema is a(n) _____ sign of cirrhosis
Answer: early
Flashcard 324: Cirrhosis typically progresses over _____+ years
Answer: 10
Flashcard 325: Vitamin B12-IF complex from the duodenum is absorbed in the _____
Answer: terminal ileum
Flashcard 326: Clinical sign = _____
Answer: Palmar erythema
Flashcard 327: Spot diagnosis = _____
Answer: Caput medusae
Flashcard 328: What is the main finding on LFTs for acute liver failure? _____
Answer: Markedly ↑↑ transaminases
Flashcard 329: What is the second-line imaging for cirrhosis if transient elastography cannot be done (e.g. significant obesity)? _____
Answer: CT scan
Flashcard 330: What is the mainstay management of uncomplicated paralytic ileus? _____
Answer: Conservative: bowel rest (NBM) & fluids
Flashcard 331: Post-abdominal surgery and absent bowel sounds / flatus, X-ray shows dilated gas-filled loops with no transition point: _____
Answer: Paralytic ileus
Flashcard 332: The _____ score is a prognostic grading scale used in cirrhosis
Answer: Child-Pugh
Flashcard 333: _____ is a rapidly progressive & severe acute hepatocellular injury associated with encephalopathy & coagulopathy
Answer: Acute liver failure
Flashcard 334: Ecchymosis/bruising is a(n) _____ sign of cirrhosis
Answer: late
Flashcard 335: _____ cirrhosis describes the symptomatic phase due to the development of portal hypertension and/or hepatocellular dysfunction
Answer: Decompensated
Flashcard 336: _____ is recommended for cirrhosis to screen for varices
Answer: Endoscopy
Flashcard 337: What is the management of paralytic ileus if signs of peritonitis? _____
Answer: Surgical referral
Flashcard 338: Acute liver failure characteristically presents with _____ symptoms ± jaundice
Answer: encephalopathy (AMS, asterixis)
Flashcard 339: What is the most accurate investigation for cirrhosis? _____
Answer: Biopsy
Flashcard 340: What are the initial investigations for acute liver failure? _____ Coagulation profile CT head to rule out alternative cause of encephalopathy
Answer: LFTs
Flashcard 341: On auscultation for paralytic ileus there are _____ bowel sounds
Answer: ↓ or absent
Flashcard 342: Neuropsychiatric symptoms of cirrhosis include hepatic _____ and asterixis ("flapping tremor")
Answer: encephalopathy
Flashcard 343: Biliary colic is more common in _____ 3:1
Answer: females
Flashcard 344: What is the initial imaging for biliary colic? _____
Answer: Abdominal US
Flashcard 345: The most common type of peptic ulcers are _____ ulcers
Answer: duodenal
Flashcard 346: Acute cholangitis is caused by _____ which results in biliary stasis → bacterial translocation into bile ducts → bacterial infection ascends the biliary tract
Answer: biliary obstruction
Flashcard 347: What is the first-line investigation for acute cholecystitis? _____
Answer: RUQ ultrasound!
Flashcard 348: What is the definitive management for ascites caused by cirrhosis? _____
Answer: Transjugular intrahepatic portosystemic shunt (TIPS)
Flashcard 349: _____ are abnormal concretions that form within the gallbladder
Answer: Gallstones
Flashcard 350: _____ is painful lymphadenopathy in the small bowel mesentery, with similar symptoms to appendicitis
Answer: Mesenteric adenitis
Flashcard 351: Acute cholecystitis characteristically presents with _____ & fever
Answer: RUQ pain
Flashcard 352: Up to ~_____% of patients with cholelithiasis have acute cholangitis
Answer: 9
Flashcard 353: Patients often report pain is worse when _____ for appendicitis
Answer: going over speed bumps
Flashcard 354: Management of spontaneous bacterial peritonitis? Prophylaxis: _____ Management: IV cefotaxime
Answer: oral ciprofloxacin
Flashcard 355: What are the risk factors for cholesterol gallstones? _____
Answer: Fat, female, fertile, > forty, fair-skinned, family history
Flashcard 356: The most common organism implicated in acute cholangitis is _____
Answer: Escherichia coli
Flashcard 357: _____ acute cholecystitis typically occurs in critically ill patients
Answer: Acalculous
Flashcard 358: On examination pain on appendicitis localises to _____ (tenderness at the junction of the lateral third & medial two-thirds of a line drawn from the R anterior supeiror iliac spine to the umbilicus)
Answer: McBurney's point
Flashcard 359: Acute cholangitis LFTs will present with ↑ _____, γ-GT, ALP, & ALT
Answer: bilirubin
Flashcard 360: What is the management of asymptomatic gallstones? Incidental finding in gallbladder: _____ Incidental finding in common bile duct: refer
Answer: none
Flashcard 361: _____ is the a acute inflammation of the appendix, typically caused by obstruction of the appendiceal lumen
Answer: Appendicitis
Flashcard 362: The cause of appendicitis appears to be caused by _____, but the exact cause is unknown
Answer: obstruction of the appendiceal lumen
Flashcard 363: Serum-ascites albumin gradient (SAAG) < _____g/L it indicates a non-portal hypertensive cause
Answer: 11
Flashcard 364: How does pain differ in appendicitis & mesenteric adenitis? _____
Answer: Mesenteric adenitis: more diffuse, can be intermittent, less severe Appendicitis: constant & proressively worsens
Flashcard 365: Ascites presents with _____ over days or months
Answer: abdominal distension
Flashcard 366: Gallstone diseases/complications are _____, acute cholecystitis, and severe complications such as cholangitis & pancreatitis
Answer: biliary colic
Flashcard 367: The prognosis of acute cholangitis is _____ with mortality between 10-30% :((
Answer: poor
Flashcard 368: A female patient with suspected appendicitis should be investigated with a _____
Answer: urine/serum β-hCG test
Flashcard 369: Spot diagnosis = _____
Answer: ascites
Flashcard 370: What investigation aside from US is recommended for all new-onset ascites? _____
Answer: Diagnostic paracentesis (US guided)
Flashcard 371: Acute cholangitis will have _____ CRP, ↑ WCC & may have +ve blood cultures
Answer: ↑
Flashcard 372: _____ is intestinal hypomotility WITHOUT bowel obstruction, subsequently leading to "functional" bowel obstruction
Answer: Paralytic ileus
Flashcard 373: What is the first-line investigation for asymptomatic gallstones? _____
Answer: There are none! because it asymptomatic... gotcha
Flashcard 374: On examination ascites can be clinically diagnosed with _____ & fluid wave test if > 1.5L of fluid
Answer: shifting dullness
Flashcard 375: The second most common cause of ascites is _____ ~10%
Answer: malignancy
Flashcard 376: Ascitic fluid analysis uses the _____ to help determine the cause
Answer: serum-ascites albumin gradient (SAAG)
Flashcard 377: _____ can present with hypotension & mental status changes in Reynold's pentad
Answer: Acute cholangitis
Flashcard 378: Patients with appendicitis _____ hungry
Answer: are NOT
Flashcard 379: What is the initial management of acute cholangitis? Fluids _____
Answer: Empiric IV antibiotics!! (piperacillin/tazobactam)
Flashcard 380: What is the management for acute cholecystitis? _____ Laparoscopic cholecystectomy within 1 week
Answer: IV antibiotics
Flashcard 381: Acute cholecystitis affects _____ 3:1 with peak incidence > 50 years old
Answer: females
Flashcard 382: On examination, _____ has a +ve Murphy's sign which is when the examiner instructs the patient to breathe out, then palpates gallbladder (RUQ), instructs the patient to breathe in, which causes inspiratory arrest because of gallbladder pain as the diaphragm pushes gallbladder down into palpated hand
Answer: acute cholecystitis
Flashcard 383: The most common pathogenesis of appendicitis in adults is _____
Answer: faecoliths
Flashcard 384: Cholesterol gallstones = radio_____ Pigmented gallstones = radiopaque
Answer: lucent
Flashcard 385: Acute cholecystitis is most commonly _____ in ~90% of patients
Answer: calculous
Flashcard 386: The _____ is a small, 5-10cm, narrow tube that comes off the caecum
Answer: appendix
Flashcard 387: _____ refers to the complications that occur with gallstones in other parts of the biliary tree
Answer: Gallstone disease
Flashcard 388: Iatrogenic cause of ascending cholangitis is _____
Answer: ERCP
Flashcard 389: What is the management for mesenteric adenitis? _____
Answer: No treatment, just analgesia if needed
Flashcard 390: Appendicitis is categorised into _____ & complicated appendicitis
Answer: Acute (simple)
Flashcard 391: The most common pathogenesis of appendicitis in children & young adults is _____
Answer: lymphoid hyperplasia
Flashcard 392: _____ often presents with RUQ abdominal pain, fever, & jaundice known as Charcot's triad
Answer: Acute cholangitis
Flashcard 393: Acute cholangitis is also known as _____
Answer: ascending cholangitis
Flashcard 394: Spontaneous bacterial peritonitis presents with ascites + _____, fever
Answer: abdominal pain
Flashcard 395: _____ is also recommended in ascites if sodium is < 125 mmol/L
Answer: Fluid restriction
Flashcard 396: Abdominal distension from ascites presents with _____, weight gain, dyspnoea, & discomfort
Answer: early satiety
Flashcard 397: Mesenteric adenitis typically improves and almost always clears up within _____
Answer: two weeks
Flashcard 398: Gallstones are typically made of _____
Answer: cholesterol 80%
Flashcard 399: _____ can occur in ascites that is most commonly caused by E. coli on ascitic fluid culture
Answer: Spontaneous bacterial peritonitis
Flashcard 400: What is the first-line imaging for appendicitis if indicated? _____
Answer: Ultrasound
Flashcard 401: Mesenteric adenitis is most commonly caused by _____
Answer: a viral infection (e.g. gastroenteritis)
Flashcard 402: Gallstones in different locations can manifst in disease: Biliary colic: _____ Acute cholecystitis: RUQ pain + fever Acute cholangitis: Charcot's triad ± Reynold's pentad Gallstone Pancreatitis: epigastric pain radiating to back
Answer: postprandial RUQ pain
Flashcard 403: What is the management of symptomatic gallstones? _____
Answer: Laparoscopic cholecystectomy
Flashcard 404: Gallstones usually present _____
Answer: asymptomatically
Flashcard 405: Appendicitis can present atypically in _____, elderly, & pregnant patients
Answer: young
Flashcard 406: _____ is the excessive accumulation of fluid within the peritoneal cavity
Answer: Ascites
Flashcard 407: Acute cholecystitis RUQ pain may radiate to the _____ because of phrenic nerve irritation
Answer: R shoulder
Flashcard 408: Median age of acute cholangitis is _____-60 years old
Answer: 50
Flashcard 409: _____ is inflammation of the gallbladder typically caused by cystic duct obstruction by a(n) gallstone
Answer: Acute cholecystitis
Flashcard 410: There are two main types of gallstones: _____ and pigmented
Answer: cholesterol
Flashcard 411: Serum-ascites albumin gradient (SAAG) ≥ _____g/L it indicates a portal hypertensive cause
Answer: 11
Flashcard 412: The characteristic presentation of _____ is diffuse periumbilical pain that localises to the right lower quadrant over ~24 hours
Answer: appendicitis
Flashcard 413: What are the risk factors for pigmented gallstones? _____
Answer: Haemolytic disease (particularly hereditary spherocytosis & sickle cell disease)
Flashcard 414: Appendicitis is typically a clinical diagnosis with _____ on blood test and negative urinalysis
Answer: neutrophil-predominant leucocytosis
Flashcard 415: What is the definitive management of acute cholangitis? _____
Answer: Biliary decompression → ERCP ± sphincterotomy or surgical management
Flashcard 416: The causes of biliary obstruction in acute cholangitis are typically _____, biliary strictures, & malignant obstruction
Answer: gallstones
Flashcard 417: What is the second-line investigation for acute cholecystitis if ultrasound is inconclusive? _____
Answer: HIDA scan
Flashcard 418: What are the red flag signs in a patient presenting with RUQ pain, fever (acute cholecysitits)? _____
Answer: Jaundice, altered mental state, hypotension → acute cholangitis
Flashcard 419: What is the first-line imaging for assessing ascites? _____
Answer: Ultrasound
Flashcard 420: Appendicitis most commonly occurs at ages _____-{{c1:19}}
Answer: 10
Flashcard 421: What is the gold-standard & therapeutic investigation for acute cholangitis? _____
Answer: ERCP
Flashcard 422: Non-specific symptoms of appendicitis include _____, anorexia, low-grade fever, bowel changes
Answer: nausea & vomiting
Flashcard 423: What is the management for ascites? _____ Spironolactone monotherapy
Answer: Dietary sodium restriction
Flashcard 424: What is the management for large, or refractory ascites? _____
Answer: Therapeutic paracentesis
Flashcard 425: Ascitic fluid analysis with neutrophils > 250 cells/ul indicates _____
Answer: spontaneous bacterial peritonitis
Flashcard 426: _____ classically presents in children/young adults with epigastric/RLQ pain following a viral infection
Answer: Mesenteric adenitis
Flashcard 427: What is the first-line investigation for symptomatic gallstones? _____ Abdominal ultrasound
Answer: LFTs
Flashcard 428: On examination appendicitis can present with _____ which is RLQ pain elicitied on deep plpation of the LLQ
Answer: Rovsing sign
Flashcard 429: The most common cause of ascites is _____ ~80%
Answer: cirrhosis (portal hypertension)
Flashcard 430: What is the interim management of acute cholecystitis in unstable or clinically deteriorating patients? _____
Answer: Gallbladder draining procedures e.g. percutaneous cholecystostomy
Flashcard 431: On examination appendicitis can present with _____ which is an abrupt increase in pain when an examiner suddenly releases palpation
Answer: Blumberg sign
Flashcard 432: On examination appendicitis can present with _____ which is RLQ pain on passive extension of R hip when patient is positioned on their left side
Answer: Psoas sign
Flashcard 433: What is the mainstay management of appendicitis? _____ + administration of IV antibiotics
Answer: Appendicectomy (laparoscopic > open approach)
Flashcard 434: In acute cholecystitis there is _____ AST & ALT, normal bilirubin, normal ALP, normal γ-GT
Answer: mildly ↑
Flashcard 435: _____ is a bacterial infection of the biliary tract, commonly due to biliary obstruction
Answer: Acute cholangitis
Flashcard 436: Paralytic ileus most commonly occurs _____
Answer: postoperatively
Flashcard 437: Different sub-types of ascites exist: _____ ascites, haemorrhagic ascites, pancreatic ascites
Answer: chylous
Flashcard 438: MALT is a type of _____ lymphoma which most commonly occurs in the stomach
Answer: Non-Hodgkin's
Flashcard 439: Stomach MALT is associated with _____ infection. Eradication of the infection can cure the condition
Answer: H-pylori
Flashcard 440: Patients with malignancy of unknown origin with presentations compatible with hepatocellular cancer should have an _____
Answer: AFP blood test
Flashcard 441: _____ is an investigation testing for the presence of C. diff in the bowel, but does not test for a current infection
Answer: GDH enzyme
Flashcard 442: The use of laxatives in constipation management should be reserved for severe cases as they can _____
Answer: permanently alter bowel function
Flashcard 443: 1st line pharmacological management of acute or chronic constipation is with a _____ laxative. If that does not work, consider changing to a osmotic (e.g. macrogol) laxative
Answer: bulk-forming (e.g. ispaghula husk)
Flashcard 444: Palliative patients with metastatic disease and symptoms of constipation may require an _____ to look for signs of bowel obstruction
Answer: AXR
Flashcard 445: If the oral route is not tolerated in palliative care, switch to _____
Answer: subcutaneous infusion
Flashcard 446: What are the most common stimulant laxatives? _____
Answer: Senna (senokot), Bisacodyl (dulcolax), Sodium picosulfate
Flashcard 447: What are the most common bulk-forming laxatives? _____
Answer: Ispaghula husk & methylcellulose
Flashcard 448: _____ are usually ineffective for opioid-induced constipation. Osmotic or stimulant laxatives should be used instead
Answer: Bulk-forming laxatives (e.g. ispaghula husk)
Flashcard 449: What are the most common stool softener laxatives? _____
Answer: Docusate or Arachis oil
Flashcard 450: What are the different categories of laxatives? _____, Osmotic, Stimulant, Stool softner
Answer: Bulk-forming
Flashcard 451: When prescribing a strong opioid, _____ should always be co-prescribed and anti-emetics should be prescribed if nausea persists
Answer: laxatives
Flashcard 452: Which drugs commonly cause constipation? _____, Iron supplements, Anti-cholinergics
Answer: Opioids
Flashcard 453: Red flag symptoms of constipation include: _____, weight loss, bleeding or iron deficiency anaemia
Answer: sudden change in bowel habit
Flashcard 454: What is the best laxative for use in palliative patients? _____
Answer: Whichever the patient finds most palatable
Flashcard 455: Patients with chronic constipation refractory to typical laxatives should be considered for management with _____ for 4 weeks
Answer: prucalopride
Flashcard 456: What are the most common osmotic laxatives? _____
Answer: Lactulose & macrogol
Flashcard 457: Laxatives should be _____ stopped once the patient is producing normal stools at least 3 times/week
Answer: gradually
Flashcard 458: It may be suitable to perform investigations for pain in palliative patients if a _____ condition may be the cause of pain
Answer: reversible
Flashcard 459: What non-opioid adjuvants can be used for intestinal colic pain? _____
Answer: Antispasmodics (e.g. buscopan)
Flashcard 460: If the cause of nausea & vomiting is unknown, a _____ is usually first line
Answer: dopamine antagonist
Flashcard 461: If nausea & vomiting is chemically mediated then the management should involve _____
Answer: correction of the chemical disturbance
Flashcard 462: If nausea & vomiting has a visceral/serosal cause then the first line management is _____ and levomepromazine
Answer: cyclizine
Flashcard 463: If nausea & vomiting is caused by reduced gastric motility then _____ should be used
Answer: pro-kinetics
Flashcard 464: Nausea and vomiting in palliative patients mediated by _____ may be caused by opioids, hypercalcaemia or chemotherapy
Answer: chemical disturbance
Flashcard 465: Nausea and vomiting in palliative patients mediated by _____ may be caused by opioids or disregulation of serotonin & dopamine receptors in the bowel
Answer: reduced gastric motility
Flashcard 466: Nausea and vomiting in palliative patients mediated by _____ may be caused by constipation or oral candidiasis
Answer: visceral/serosal mechanisms
Flashcard 467: _____ is inflammation of the liver caused by infection with the hepatitis C virus; it is primarily transmitted through exposure to infected blood
Answer: Hepatitis C
Flashcard 468: Autoimmune hepatitis can present with _____ in ~40% of patients and ~30% have cirrhosis at the time of presentation
Answer: jaundice
Flashcard 469: Type _____ autoimmune hepatitis typically affects younger patients but can affect all ages
Answer: 2
Flashcard 470: _____ is a rare cause of chronic hepatitis suspected to be caused by molecular mimicry
Answer: Autoimmune hepatitis
Flashcard 471: In ~40% of patients autoimmune hepatitis can preset acutely with prodromal _____
Answer: flu-like symptoms
Flashcard 472: If a case of hepatitis C is suspected then notify _____
Answer: Public Health
Flashcard 473: The main types of autoimmune hepatitis are _____, type 2, & type 3
Answer: type 1
Flashcard 474: What is the definitive management of autoimmune hepatitis? _____
Answer: Liver transplant; 10-20% have this during their lifetime
Flashcard 475: Patients with autoimmune hepatitis should take _____ supplementation because of steroid treatment
Answer: calcium & vitamin D
Flashcard 476: Chronic hepatitis C can be complicated with _____ which can lead to hepatocellular carcinoma
Answer: cirrhosis
Flashcard 477: Type _____ autoimmune hepatitis antibodies are anti-nuclear antibodies (ANA) ± anti-smooth muscle antibodies (SMA)
Answer: 1
Flashcard 478: How do you diagnose autoimmune hepatitis? _____ -ve test for viral hepatitis High titers of autoantibodies + clinical findings
Answer: LFTs → raised ALT & AST
Flashcard 479: What is the mainstay specialist management of hepatitis C? _____
Answer: Identify HCV genotyping → presence or abscence of cirrhosis Then treat with direct-acting antivirals (DAAs)
Flashcard 480: How is hepatitis C transmitted? _____ Pre 1991 it was spread through blood transfusions
Answer: Through infected blood via needles
Flashcard 481: Type _____ autoimmune hepatitis antibodies are anti-soluble liver antigens (anti-SLA) ± liver-pancreas antigen (anti-LP)
Answer: 3
Flashcard 482: Patients with autoimmune hepatitis should be vaccinated against _____ & B
Answer: hepatitis A
Flashcard 483: There are 2 main types of hepatitis C; _____ & Chronic
Answer: Acute
Flashcard 484: Autoimmune hepatitis is associated with other autoimmune diseases, most commonly _____
Answer: autoimmune thyroid disease
Flashcard 485: Type _____ autoimmune hepatitis typically affects women in their 40s/50s but can affect all ages
Answer: 1
Flashcard 486: Active management for acute hepatitis B is _____
Answer: entecavir or tenofovir
Flashcard 487: What is the definitive management of fulminant hepatitis? _____
Answer: Liver transplant considered, there is a high risk of mortality
Flashcard 488: In a patient with autoimmune hepatitis, be wary of _____ co-morbidity as it can cause malabsorption of immunosuppressive drugs
Answer: coeliac disease
Flashcard 489: What is the referral for Hepatitis C? _____
Answer: Referred for specialist care
Flashcard 490: How do you diagnose autoimmune hepatitis if immunological blood tests are inadequate? _____
Answer: Liver biopsy
Flashcard 491: Type _____ autoimmune hepatitis antibodies are anti-liver kidney microsomal-1 (LKM-1) ± anti-liver cytosolic-1 (LC-1)
Answer: 2
Flashcard 492: What is the mainstay management of autoimmune hepatitis? _____
Answer: Immunosuppressive therapy (prednisolone) by expert hepatologist/gastroenterologist
Flashcard 493: Management of chronic hepatitis B includes regular _____ & antiviral medication may be offered
Answer: monitoring
Flashcard 494: What is the mainstay investigation to diagnose hepatitis C? _____ → HCV RNA (if anti-HCV antibody test is +ve)
Answer: Anti-HCV antibodies
Flashcard 495: Type _____ autoimmune hepatitis is the most common (70-80%)
Answer: 1
Flashcard 496: Most patients with acute hepatitis C present _____; but can present with jaundice, fatigue, & arthralgia
Answer: asymptomatically
Flashcard 497: _____ hepatitis C < 6 months Chronic hepatitis C > 6 months after initial infection
Answer: Acute
Flashcard 498: Type _____ autoimmune hepatitis is the most severe
Answer: 2
Flashcard 499: Hepatitis A serology with -ve HAV-IgM & +ve HAV-IgG indicates _____ or immunity
Answer: past hepatitis A infection
Flashcard 500: When monitoring chronic hepatitis B do LFTs every _____ & hepatic US every 6 months
Answer: 6 months
Flashcard 501: Hepatitis A prognosis = _____
Answer: Typically self-limiting & does not cause long-term liver damage
Flashcard 502: Hepatitis B can be transmitted during child birth due to infected bodily fluids (_____)
Answer: vertical transmission
Flashcard 503: Hepatitis B serology: HbsAg _____ Anti-HBs +ve Anti-HBc -ve = previous vaccination
Answer: -ve
Flashcard 504: Hepatitis A incubation period is ~ _____
Answer: 28 days
Flashcard 505: Hepatitis A resolution phase lasts up to _____ & can presents with malaise & hepatic tenderness
Answer: 6 months
Flashcard 506: Hepatitis A serology with +ve HAV-IgM & +ve HAV-IgG indicates _____
Answer: actue hepatitis A infection
Flashcard 507: LFTs for hepatitis A will show: _____ ALT & AST Normal or ↑ bilirubin Normal or ↑ PT
Answer: Significantly ↑
Flashcard 508: Hepatitis A clinical features can be split up into phases: _____ Icteric (2 weeks): Jaundice (80%), cholestasis (dark urine & pale stools), pruritus Resolution: Period of recovery up to 6 months
Answer: Prodromal (3-10 days): RUQ pain, flu-like symptoms, nausea & vomiting
Flashcard 509: What is the mainstay management of Hepatitis A? _____
Answer: Syptomatic treatment Admit to hospital if necessary
Flashcard 510: Hepatitis B serology: _____ is positive when there is previous or current infection
Answer: Hepatitis B core antibody (anti-HBc)
Flashcard 511: There are 3 main types of hepatitis B; _____ & Fulminant, Chronic
Answer: Acute
Flashcard 512: Complications of chronic hepatitis B include _____ which can progress into hepatocellular carcinoma
Answer: cirrhosis
Flashcard 513: Most patients with chronic hepatitis B present _____; but can present with symptoms of chronic liver disease as well as a PMH of acute hepatitis B
Answer: asymptomatically
Flashcard 514: Hepatitis A usually lasts < _____
Answer: 3 months
Flashcard 515: Hepatitis A icteric phase lasts _____ & presents with jaundice, cholestasis & ± pruritus
Answer: 2 weeks
Flashcard 516: Hepatitis B serology: HbsAg _____ Anti-HBs -ve Anti-HBc IgM +ve = Acute Hepatitis B
Answer: +ve
Flashcard 517: Hepatitis A is transmitted via the _____
Answer: faecal-oral route
Flashcard 518: Hepatitis B serology: HbsAg _____ Anti-HBs -ve Anti-HBc IgG +ve = Chronic hepatitis B
Answer: +ve
Flashcard 519: Hepatitis B is more commonly spread via _____ & sharing needles (IVDU)
Answer: sexual contact
Flashcard 520: Hepatitis A symptoms often improve once _____ occurs
Answer: jaundice
Flashcard 521: If a case of hepatitis B is suspected then _____
Answer: notify public health
Flashcard 522: If an outbreak of hepatitis A is suspected or the patient is a food handler, then _____
Answer: notify the local Health Protection Unit promptly
Flashcard 523: Hepatitis B serology: HbsAg _____ Anti-HBs +ve Anti-HBc +ve = previous infection
Answer: -ve
Flashcard 524: Approximately _____% of infants born to hepatitis B +ve mothers will get chronic hepatitis B
Answer: 10
Flashcard 525: What is the lifestyle advice must be given to anyone with hepatitis? _____
Answer: Lay off the alcohol buddy
Flashcard 526: Hepatitis B serology: _____ is positive when there is immunity from previous infection or vaccination
Answer: Hepatitis B surface antibody (anti-HBs)
Flashcard 527: Hepatitis B serology: HbsAg _____ Anti-HBs -ve Anti-HBc -ve = susceptible
Answer: -ve
Flashcard 528: What initial investigations should be done for hepatitis A? _____
Answer: Hepatitis A serology & LFTs
Flashcard 529: Those at high risk of Hepatitis A (e.g. close contact) can be offered a _____
Answer: vaccination
Flashcard 530: LFTs for hepatitis B will show: _____ ALT & AST Normal or ↑ bilirubin ↑ PT
Answer: Significantly ↑
Flashcard 531: _____ is a self-limiting infection with hepatitis A virus that causes inflammation of the liver
Answer: Hepatitis A
Flashcard 532: What is the mainstay management of Hepatitis B? _____
Answer: Symptomatic treatment Admit to hospital if necessary
Flashcard 533: What initial investigations should be done for hepatitis B? _____
Answer: Hepatitis B serology, LFTs, & ultrasound
Flashcard 534: Hepatitis A prodromal phase lasts _____ & presents with flu-like illness, nausea & vomiting, with RUQ pain
Answer: 3 to 10 days
Flashcard 535: Patients with hepatitis A should excluded from work, school, or nursery _____ after onset of jaundice or 7 days after symptom onset if no history of jaundice
Answer: 7 days
Flashcard 536: Hepatitis A presents with _____ pain
Answer: RUQ
Flashcard 537: What hepatitis A serology results are taken? 1st-line = _____ Alternative = HAV-IgM & HAV-IgG
Answer: PCR for hepatitis A RNA
Flashcard 538: What investigatory result helps distinguish between viral hepatitis & alcoholic hepatitis? _____
Answer: Both have elevated ↑ aminotransferases AST:ALT ratio will be significantly higher in alcoholic hepatitis (AST is significantly raised compared to ALT) AST:ALT ratio usually 1:1 in viral hepatitis AST:ALT ratio usually 2:1 in alcoholic hepatitis
Flashcard 539: _____ hepatitis is rare (~0.5%) and causes jaundice, AMS, asterixis, cerebral oedema...
Answer: Fulminant
Flashcard 540: Most patients with acute hepatitis B present _____; but can present with jaundice, RUQ pain, & nausea + vomiting
Answer: asymptomatically
Flashcard 541: Hepatitis B serology: _____ is positive when there is current infection (acute or chronic)
Answer: Hepatitis B surface antigen (HBsAg)
Flashcard 542: _____ is inflammation of the liver caused by infection with the hepatitis B virus; it is the most prevalent hepatitis viral infection
Answer: Hepatitis B
Flashcard 543: _____ may be considered in patients who have had 2 or more episodes of C.diff infection
Answer: Faecal transplant
Flashcard 544: C. diff stool antigen testing shows _____
Answer: exposure to C. diff
Flashcard 545: What is the management of first episode C. diff? _____ & Oral vancomycin for 10 days
Answer: Stop current ABX if possible
Flashcard 546: Life threatening C. diff infections are indicated by findings such as: _____, ileus, toxic megacolon
Answer: hypotension
Flashcard 547: C. diff will usually present with _____ and abdominal pain
Answer: diarrhoea
Flashcard 548: Diarrhoea due to C. diff infection should resolve within _____ weeks
Answer: 1-2
Flashcard 549: What is the management of recurrent C. diff after _____? Stop current ABX if possible & Oral vancomycin OR fidaxomicin
Answer: 12 weeks
Flashcard 550: C. diff bacteria produce an _____ which damages the intestines and can cause pseudomembranous colitis
Answer: exotoxin
Flashcard 551: People who have had a C. diff infection should stay away from work or school until they have been diarrhoea free for _____
Answer: 48 hrs
Flashcard 552: C. diff is a gram-_____
Answer: positive rod
Flashcard 553: What is the diagnostic test for C. diff infection? _____
Answer: C. diff toxin stool test
Flashcard 554: Blood tests will often show _____ in C. diff infection
Answer: raised WCC
Flashcard 555: Aside from antibiotics, what other medication increases risk of C. diff? _____
Answer: PPIs
Flashcard 556: What is the management of life-threatening C. diff? _____ & Oral vancomycin AND IV metronidazole
Answer: Stop current ABX if possible
Flashcard 557: What is the management of recurrent C. diff within _____? Stop current ABX if possible & Oral fidaxomicin
Answer: 12 weeks
Flashcard 558: Historically, it was thought that _____ was responsible for causing C. diff infections Currently the no. 1 cause of C. diff infections is 2nd and 3rd generation cephalosporins
Answer: Clindamycin
Flashcard 559: ~90% of pancreatic cancers are _____, most of which develop in the head of the pancreas
Answer: adenocarcinomas
Flashcard 560: What is the management for small bowel obstruction caused by hernias? _____
Answer: 100% surgical
Flashcard 561: _____ is the sudden inflammation of the pancreas pancreas characterised by abdominal pain & elevated pancreatic enzymes
Answer: Acute pancreatitis
Flashcard 562: To diagnose irritable bowel syndrome, other diagnosis should be considered e.g. _____
Answer: IBD, colorectal cancer, coeliac disease
Flashcard 563: Types of hiatus hernia: _____ Rolling (paraoesophageal)
Answer: Sliding
Flashcard 564: Hiatus hernia can present as symptoms associated with _____
Answer: GORD
Flashcard 565: Surgical management for hiatus hernia is only indicated in _____
Answer: symptomatic paraesophageal (sliding) hiatus hernia
Flashcard 566: Pancreatic cancer is often diagnosed _____ as it tends to present non-specifically
Answer: late
Flashcard 567: _____ bowel obstruction is more likely to present with vomiting
Answer: Small
Flashcard 568: What imaging is done for acute pancreatitis alongside serum amylase? _____
Answer: US imaging → important to assess aetiology (e.g. gallstones)
Flashcard 569: What is the initial test for pancreatic cancer? _____
Answer: US - 75% sensitivity
Flashcard 570: _____ bowel obstruction tends to have less severe & more gradual symptoms
Answer: Large
Flashcard 571: What is the management of perforated large bowel obstruction? _____ + IV antibiotics
Answer: Surgical
Flashcard 572: Pancreatic cancer causes _____ jaundice which results in pale stools & dark urine
Answer: obstructive
Flashcard 573: Hiatus hernia are often found incidentally during an _____
Answer: endoscopy
Flashcard 574: In pancreatic cancer what masses may be palpated on examination? _____
Answer: Hepatomegaly and/or the gallbladder (invasion/mets)
Flashcard 575: Serum _____ is more sensitive & specific for acute pancreatitis
Answer: lipase
Flashcard 576: Pancreatitis can be complicated with _____
Answer: acute respiratory distress syndrome
Flashcard 577: Serum amylase is typically x_____ times the upper limit of normal in acute pancreatitis
Answer: 3
Flashcard 578: Pathogenesis of acute pancreatitis: _____
Answer: Most commonly gallstones or alcohol causing autodigestion of the pancreatic tissue. The proteases digest the blood vessels leading to amylase & lipase being released into the blood. Lipases can cause fat necrosis leading to Grey Turner's sign
Flashcard 579: Recurrent abdominal pain in irritable bowel syndrome is often related to _____ or associated with a change in stool frequency and/or stool form
Answer: defecation
Flashcard 580: > 90% of pancreatic cancers have a _____ mutation
Answer: KRAS
Flashcard 581: Pancreatic cancers have a terrible prognosis because _____
Answer: they nearly always present late
Flashcard 582: On CT scan a "_____" sign is indicative of pancreatic cancer
Answer: double duct
Flashcard 583: What is the initial investigation for acute pancreatitis? _____
Answer: Pancreatic enzymes → amylase & lipase
Flashcard 584: What abdominal x-ray findings are associated with large bowel obstruction? _____ [By James Heilman, MD - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=4646177]
Answer: Dilated loops of large bowel with air-fluid levels
Flashcard 585: What is the mainstay management in pancreatic cancer? _____
Answer: Palliative with analgesia
Flashcard 586: Large bowel obstruction presents with abdominal pain, _____ and abdominal distenion
Answer: absolute constipation
Flashcard 587: Management for hiatus hernia? Advice = _____ Medical = PPI if symptomatic
Answer: Weight loss
Flashcard 588: What is the pharmacological management of refractory abdominal pain in IBS after anti-spasmodics? 1st _____ 2nd SSRI
Answer: low dose TCA
Flashcard 589: What is the mainstay management of pancreatitis? _____
Answer: Fluid resuscitation & analgesia (IV opioids)
Flashcard 590: Small bowel is considered dilated if > _____cm diameter
Answer: 3
Flashcard 591: The cause of Irritable Bowel Syndrome is unknown and thought to be linked to _____-gut axis dysregulation as well as other factors
Answer: brain
Flashcard 592: _____ is a chronic functional disorder characterised by abdominal pain, bloating, change in bowel habit caused by gut-brain axis dysregulation
Answer: Irritable bowel syndrome IBS
Flashcard 593: What is the management of large bowel obstruction? _____
Answer: Conservative or surgical
Flashcard 594: What is the management for small bowel obstruction caused by adhesions? _____
Answer: Conservative management → some may require surgery
Flashcard 595: Advanced pancreatic cancer can present with _____ because of loss of exocrine function
Answer: steatorrhea
Flashcard 596: Pancreatic cancer classically presents as _____
Answer: painless jaundice
Flashcard 597: What is the management in pancreatic cancer of the head where the tumour can be resected? _____
Answer: Whipple's procedure (pancreaticoduodenectomy) with adjuvant chemotherapy
Flashcard 598: Causes of acute pancreatitis: _____
Answer: Idiopathic Gallstones Ethanol Trauma Steroids Mumps (other viruses e.g. Cocksackie B) Autoimmune (e.g. polyarteritis nodosa) Scorpion sting HYPERcalcaemia, hypertriglyceridaemia, hyperchylomicronaemia Hypothermia ERCP Drugs (azathiprine, mesalazine, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate)
Flashcard 599: What is the pharmacological management of irritable bowel syndrome? Pain = _____ Diarrhoea = anti-diarrheal (e.g. loperamide) Constipation = laxative (e.g. bulk-forming) → linaclotide 2nd-line
Answer: antispasmodic drug (e.g. Mebeverine, peppermint oil)
Flashcard 600: Acute pancreatitis is usually caused by: _____ alcoholism (30%)
Answer: gallstones (50%)
Flashcard 601: What are the biggest risk factors for pancreatic cancer? 1 Smoking 2 Diabetes mellitus (esp T2DM) 3 Chronic _____ 3 Obesity 4. Family history
Answer: pancreatitis
Flashcard 602: A patient presenting with large bowel obstruction may have a Family Hx of _____ and/or colorectal cancer
Answer: IBD
Flashcard 603: What is the first-line investigation for hiatus hernia? _____
Answer: Barium swallow
Flashcard 604: What is the first-line investigation for large bowel obstruction? _____
Answer: AXR
Flashcard 605: A patient presenting with large bowel obstruction may have a HPx of _____ and/or change in bowel habit
Answer: rectal bleeding
Flashcard 606: Risk factors for hiatus hernia included increased intra-abdominal pressure e.g. _____
Answer: obesity
Flashcard 607: What is the definitive investigation for small bowel obstruction? _____
Answer: CT scan
Flashcard 608: Acute pancreatitis classically presents with _____ pain that may radiate to the back
Answer: severe epigastric
Flashcard 609: Should antibiotics be given for pancreatitis? _____
Answer: Not routinely → potential indications are infected pancreatic necrosis
Flashcard 610: What is the definitive investigation for large bowel obstruction? _____
Answer: CT
Flashcard 611: What are the LFT results for pancreatic cancer? _____
Answer: Obstructive: ↑ bilirubin ↑ ALP ALT & AST may be raised if hepatocellular dysfunction is present
Flashcard 612: A _____ occurs when part of the stomach protrudes through the diaphragm up into the thoracic cavity
Answer: hiatus hernia
Flashcard 613: What is the management of IBS if symptoms do not respond to pharmacological treatments after 12 months? _____
Answer: Psychological interventions - CBT, hypnotherapy
Flashcard 614: The _____ score is a scoring system for severity & prognosis of pancreatitis
Answer: Glasgow
Flashcard 615: Small bowel obstruction is managed with _____ to aspirate content for "decompression"
Answer: NG tube
Flashcard 616: _____ is a physical sign that is described as ecchymotic discolouration of the flank due to severe necrotising pancreatitis in acute pancreatitis
Answer: Grey Turner's Sign
Flashcard 617: What is the investigation of choice for pancreatic cancer? _____
Answer: High resolution CT scan
Flashcard 618: _____ diagnosis should be considered if the patient has the following for ≥ 6 months: Abdominal pain and/or Bloating and/or Change in bowel habit
Answer: Irritable Bowel Syndrome
Flashcard 619: _____ is the tumour maker indicative of pancreatic cancer
Answer: CA19-9
Flashcard 620: Lifestyle advice for IBS... _____
Answer: - Eat regular meals and take time to eat - Avoid missing meals - Drink at least 8 cups of fluid per day - Restrict tea & coffee to 3 cups a day - Reduce intake of alcohol & fizzy drinks - Limit intake of high-fibre food - Limit fresh fruit to 3 portions a day - Encourage oats for wind & bloating - Encourage regular physical activity
Flashcard 621: _____ suggests that a palpable, nontender/painless gallbladder is caused by pancreatic / gallbladder cancer, not a stone.
Answer: Courvoisier's law
Flashcard 622: Patients with small bowel obstruction should be nil _____
Answer: by mouth
Flashcard 623: What is the initial management of bowel obstruction? (small & large) _____ NG tube for decompression IV fluids
Answer: Nil by mouth
Flashcard 624: Investigations for Irritable Bowel Syndrome? FBC, CRP _____ Coeliac serology (tissue transglutaminase antibodies)
Answer: Faecal calprotectin
Flashcard 625: Serum amylase _____ prognostic for pancreatitis
Answer: is not
Flashcard 626: Small bowel obstruction is managed with IV fluid resuscitation for _____
Answer: hydration
Flashcard 627: Is pancreatic cancer always painless? _____
Answer: No → it can often present with pain that radiates to the back
Flashcard 628: A large bowel obstruction is the initial complaint of _____ in ~20% of cases
Answer: colorectal cancer
Flashcard 629: A alcoholic patient experiences sudden-onset severe epigastric pain that radiates to the back, vomiting, and has discolouration on the flank. What is the likely diagnosis? _____
Answer: Acute pancreatitis
Flashcard 630: _____ is the blockage of the large intestine that impedes passage of intestinal contents
Answer: Large bowel obstruction
Flashcard 631: What are the most common causes of large bowel obstruction? 1st _____ ~60% 2nd Diverticular disease
Answer: Colorectal cancer
Flashcard 632: _____ is characterised by superficial (submucosa) continuous inflammation
Answer: Ulcerative colitis
Flashcard 633: Crohn disease is characterised histologically by lymphoid aggregates with _____
Answer: noncaseating granulomas
Flashcard 634: Acutely thrombosed external haemorrhoids should be managed with _____ if presented in < 3-4 days
Answer: excision
Flashcard 635: Perianal abscesses can be caused by underlying IBD, especially _____
Answer: Crohn's
Flashcard 636: What drug is used for refractory or fistulating Crohn's disease? _____
Answer: Infliximab
Flashcard 637: _____ is more common in Crohn's
Answer: Episcleritis
Flashcard 638: _____ is a collection of pus that forms in the subcutaneous tissue surrounding the anal sphincter due to an infection
Answer: Perianal abscess
Flashcard 639: What is the investigation of choice for severe colitis in ulcerative colitis? _____
Answer: Flexible sigmoidoscopy
Flashcard 640: Acutely thrombosed external haemorrhoids should be managed with _____ if presented in > 3-4 days
Answer: Analgesia, warm sitz baths, ice packs, & stool softeners
Flashcard 641: Smoking results in: _____ risk for Crohn disease ↓ risk for Ulcerative colitis
Answer: ↑
Flashcard 642: Triggers of ulcerative colitis: - Stress - Medications (_____, antibiotics) - Cessation of smoking
Answer: NSAIDs
Flashcard 643: Crohn's disease is more susceptible to strictures, fistulas, & adhesions because _____
Answer: of transmural inflammation → more complete loss of bowel wall integrity
Flashcard 644: The cause of Crohn's disease is unknown, but there is a strong _____
Answer: genetic susceptibility
Flashcard 645: What is the surgical management of ulcerative colitis? _____
Answer: Total proctocolectomy
Flashcard 646: What ophthalmological pathologies are associated with IBD? _____ (related to disease activity) Uveitis (unrelated to disease activity)
Answer: Episcleritis
Flashcard 647: When are antibiotics used in perianal abcesses? _____
Answer: If there is systemic upset secondary to the abscess.
Flashcard 648: Small bowel obstruction results in bowel _____ proximal to the obstruction, and bowel collapse distal to the obstruction
Answer: dilation
Flashcard 649: What is the investigation of choice for ulcerative colitis? _____
Answer: Colonoscopy + biopsy
Flashcard 650: What is the most common surgery for Crohn's? _____
Answer: Ileocecal resection
Flashcard 651: Small bowel obstruction types: - _____ - Complete
Answer: Partial
Flashcard 652: Crohn's disease is characterised by _____ lesions, which can occur anywhere from the mouth to the anus
Answer: skip
Flashcard 653: _____ is the blockage of the small intestine that impedes passage of intestinal contents
Answer: Small bowel obstruction
Flashcard 654: What is the final-line surgical management for haemorrhoids? _____ or haemorrhoidal artery ligation
Answer: Haemorrhoidectomy
Flashcard 655: ~_____% of patients with Crohn's will eventually have surgery
Answer: 70
Flashcard 656: _____ on a blood test correlates well with disease activity of Crohn's
Answer: CRP
Flashcard 657: _____ may cause watery diarrhoea and weight loss
Answer: Crohn's disease
Flashcard 658: The average age of perianal abscess incidence is _____ years old
Answer: 40
Flashcard 659: _____ is a relapsing-remitting inflammatory bowel disease that involves continuous superficial (intestinal mucosa) inflammation of the rectum and large bowel
Answer: Ulcerative colitis
Flashcard 660: Which form of inflammatory bowel disease is characterized by continuous colonic involvement? _____
Answer: Ulcerative colitis
Flashcard 661: Patients with a perianal abcess may also have noticed _____
Answer: hardened tissue in the anal region
Flashcard 662: What abdominal x-ray findings are associated with small bowel obstruction? _____
Answer: Dilated loops of small bowel with air-fluid levels
Flashcard 663: Small bowel obstruction can present with nausea & vomiting, typically _____ vomiting
Answer: bilious
Flashcard 664: What is the management for inducing remission in severe ulcerative colitis? _____! 1st-line: IV steroids 72 hours no improvement → add IV steroids + ciclosporin
Answer: Admit to hospital
Flashcard 665: Why can Crohn's cause vitamin B12 deficiency? _____
Answer: Damage to the terminal ielum
Flashcard 666: What is an important differential for Crohn's? _____
Answer: Appendicitis
Flashcard 667: Crohn's disease most commonly affects the _____ but can occur anywhere between the mouth to anus
Answer: terminal ileum
Flashcard 668: _____ may cause bloody or non-bloody diarrhoea
Answer: Crohn's disease
Flashcard 669: _____ is seen in ulcerative colitis
Answer: Primary sclerosing cholangitis
Flashcard 670: Acutely thrombosed external haemorrhoids typically present with _____ and appear purplish & oedematous
Answer: significant pain
Flashcard 671: _____ is characterised by full-thickness/transmural inflammation
Answer: Crohn's disease
Flashcard 672: What is the management for inducing remission in Crohn's? 2nd-line: _____
Answer: 5-ASA drugs
Flashcard 673: Perianal abscesses are generally colonised by gut flora (_____)
Answer: E coli
Flashcard 674: What is the most common cause of small bowel obstruction in children? _____
Answer: Hernias
Flashcard 675: What is the management for inducing remission in mild-to-moderate ulcerative colitis? 1st-line: _____ Remission not achieved within 4 weeks → add oral 5-ASA
Answer: topical 5-ASA
Flashcard 676: What is the investigation of choice for Crohn's disease? _____
Answer: Colonoscopy + biopsy
Flashcard 677: What is the management for maintaining remission in severe ulcerative colitis? _____ or mercaptopurine
Answer: Azathioprine
Flashcard 678: What is the management of a perianal abscess? _____
Answer: Incision & drainage
Flashcard 679: What is the investigation for a perianal abscess when identifying the underlying cause? _____ may be used
Answer: Colonoscopy + blood tests
Flashcard 680: _____ accounts for ~80% of cases of intestinal obstruction
Answer: Small bowel obstruction
Flashcard 681: Ulcerative colitis always starts at the _____ but can spread up to the ileocaecal valve
Answer: rectum
Flashcard 682: Which inflammatory bowel disease is associated with a "lead pipe" appearance of the colon on AXR following barium enema? _____
Answer: Ulcerative colitis → loss of haustra
Flashcard 683: What dermatological pathologies are associated with IBD? _____ (related to disease activity) Pyoderma gangrenosum (unrelated **)
Answer: Erythema nodosum
Flashcard 684: What is the most common cause of small bowel obstruction? 1st _____ 2nd Hernias
Answer: Adhesions → previous abdominal surgery
Flashcard 685: Which inflammatory bowel disease is commonly associated with toxic megacolon? _____
Answer: Ulcerative colitis
Flashcard 686: Small bowel obstruction presents with _____ in complete obstruction
Answer: absolute constipation
Flashcard 687: Ulcerative colitis is characterised histologically by _____ with neutrophils, ulcers, and bleeding
Answer: crypt abscesses
Flashcard 688: Crohn disease is typically characterised by _____ lower quadrant pain/masses
Answer: right
Flashcard 689: What investigation is used for toxic megacolon? _____
Answer: AXR → colonic dilation
Flashcard 690: A _____ is an inflammatory tract / connection between the anal canal and perianal skin
Answer: perianal fistula
Flashcard 691: _____ always causes bloody diarrhoea
Answer: Ulcerative colitis
Flashcard 692: On abdominal examination, small bowel obstruction can present with _____, particularly in low/distal SBO
Answer: abdominal distension
Flashcard 693: What is the smoking advice for patients with Crohn's? _____
Answer: Stop smoking!
Flashcard 694: On auscultation of small bowel obstruction a "_____" sound may be heard
Answer: tinkling
Flashcard 695: What is the investigation of choice for perianal fistulae? _____
Answer: MRI
Flashcard 696: Crohn's can present with non-specific symptoms such as _____
Answer: weight loss
Flashcard 697: _____ is the most common type of anorectal abscess
Answer: Perianal abscess
Flashcard 698: _____ is a relapsing-remitting inflammatory bowel disease that involves full-thickness inflammation from the mouth to the anus
Answer: Crohn's disease
Flashcard 699: Ulcerative colitis is typically characterised by _____ lower quadrant pain
Answer: left
Flashcard 700: Perianal abscesses are more common in _____
Answer: men
Flashcard 701: What is the management for maintaining remission in Crohn's? 2nd-line: _____
Answer: methotrexate
Flashcard 702: _____ are seen in ulcerative colitis as a result of mucosal erosion
Answer: Inflammatory pseudopolyps
Flashcard 703: Small bowel obstruction presents with _____ abdominal pain
Answer: diffuse, central
Flashcard 704: Symptoms of ulcerative colitis include: _____ urgency, episodic/chronic diarrhoea (+ blood and mucus); and crampy discomfort (not pain).
Answer: bowel
Flashcard 705: Which form of inflammatory bowel disease is characterized by pseudopolyps? _____
Answer: Ulcerative colitis
Flashcard 706: What is the most common cause of small bowel obstruction in adults? _____
Answer: Adhesions
Flashcard 707: _____ is more common
Answer: Ulcerative colitis
Flashcard 708: The cause of ulcerative colitis is unknown, but there is a strong _____
Answer: genetic susceptibility
Flashcard 709: Which form of inflammatory bowel disease typically spares the rectum? _____
Answer: Crohn's disease
Flashcard 710: What is the management of haemorrhoids in secondary care, non-surgical? _____ > injection scleropathy
Answer: Rubber band ligation
Flashcard 711: What investigation can help differentiate between inflammatory bowel disease & irritable bowel syndrome? _____
Answer: Faecal calprotectin
Flashcard 712: Crohn's disease typically presents in _____
Answer: childhood
Flashcard 713: What is the management for maintaining remission in Crohn's? 1st-line: _____ or mercaptopurine
Answer: Azathioprine
Flashcard 714: Ulcerative colitis can present with the feeling of needing to pass bowels when they are empty (_____)
Answer: tenesmus
Flashcard 715: Perianal abscesses present as _____ around the anus, worse when sitting
Answer: pain
Flashcard 716: _____ is more common in ulcerative colitis
Answer: Uveitis
Flashcard 717: Patients with Crohn's disease are predisposed to _____
Answer: osteoporosis
Flashcard 718: What is the first-line investigation for small bowl obstruction? _____ in supine position
Answer: AXR
Flashcard 719: Flares of ulcerative colitis: _____: < 4 stools daily, no more than small amounts of blood + no systemic disturbance + normal CRP/ESR Moderate: 4-6 stools daily + minimal systemic disturbance Severe: > 6 stools daily, visible blood + evidence of systemic disturbance
Answer: Mild
Flashcard 720: What is the management for maintaining remission in mild-to-moderate ulcerative colitis with extensive disease? _____
Answer: Oral 5-ASA
Flashcard 721: What investigation is done to confirm diagnosis of Crohn's disease? _____
Answer: Endoscopy
Flashcard 722: What is the management for inducing remission in mild-to-moderate ulcerative colitis with extensive disease? First-line: _____
Answer: topical 5-ASA + high-dose oral 5-ASA
Flashcard 723: What is the initial investigation for a perianal abscess? _____
Answer: Inspection & PR exam
Flashcard 724: What drug is often used for isolated peri-anal Crohn's disease? _____
Answer: Metronidazole
Flashcard 725: What is the primary management of haemorrhoids? _____
Answer: Soften stools → ↑ dietary fibre + ↑ fluid intake Simple analgesia/topical anaesthetics Lifestyle advice = minimise straining + good hygiene
Flashcard 726: What is the management for inducing remission in Crohn's? 1st-line: _____
Answer: Glucocorticoids (prednisolone, methylprednisolone, or IV hydrocortisone) or budesonide
Flashcard 727: What is the management for maintaining remission in mild-to-moderate ulcerative colitis? _____
Answer: Topical (rectal) 5-ASA
Flashcard 728: What is the management of perianal fistulae? First-line: _____ Second-line: Surgical - fistulotomy, seton placement
Answer: Metronidazole
Flashcard 729: _____ haemorrhoids are painless
Answer: Internal
Flashcard 730: A 70 years old patient presents complaining of progressive dysphagia and weight loss. Past medical history is positive for GORD. She has a 40 pack year history of smoking. Barium swallow reveals asymmetric narrowing of the lumen. What is the most likely diagnosis? _____ *Bonus - what type?
Answer: Oesophageal cancer
Flashcard 731: Describe what the Faecal Immunochemical Test (FIT) is... ..._____
Answer: Sent through post → faecal occult blood test that identifies human Hb → quantifies the amount
Flashcard 732: If diverticulitis presents with guarding, rigidity, & rebound tenderness then it may be complicated diverticulitis with _____
Answer: perforation
Flashcard 733: _____ ↑ the risk of colorectal cancer
Answer: IBD
Flashcard 734: What is the investigation of choice for suspected oesophageal cancer? _____
Answer: Upper GI endoscopy
Flashcard 735: What is the alternative investigation for oesophageal cancer if endoscopy is not tolerated? _____
Answer: Barium swallow (rare)
Flashcard 736: The NHS offers _____ screening for colorectal cancer every 2 years to patients aged 54-74 years
Answer: Faecal Immunochemical Test (FIT)
Flashcard 737: How much of the oesophageal lumen is blocked typically before oesophageal cancer becomes symptomatic? _____
Answer: 2/3rds
Flashcard 738: _____ haemorrhoids = originate below the dentate line (prone to thrombosis & may be painful) Internal haemorrhoids = originate above the dentate line (generally painless)
Answer: External
Flashcard 739: What is the investigation of choice for suspected colorectal carcinoma? _____
Answer: Colonoscopy
Flashcard 740: _____ colorectal cancer is managed with a left hemicolectomy
Answer: Distal transverse, descending colon
Flashcard 741: If an uncomplicated diverticulitis is refractory to treatment then it may suggest an _____
Answer: abscess
Flashcard 742: Quick Interpretation: _____ [Credit: British Journal of General Practice]
Answer: Sister Mary Joseph nodule seen in GI / pelvic cancer (metastasis)
Flashcard 743: _____ colorectal cancer is managed with a right hemicolectomy
Answer: Caecal, asceding colon, proximal transverse colon
Flashcard 744: If a patient does not meet the 2-week-wait criteria for colorectal carcinoma, then they can be investigated with _____
Answer: Faecal Immunochemical Test (FIT)
Flashcard 745: What is the investigation for haemorrhoids? _____
Answer: Digital Rectal Exam)
Flashcard 746: Acute appendicits can rarely occur in _____-sided colorectal carcinoma
Answer: right
Flashcard 747: Colorectal cancer MAJOR risk factors are _____ & age
Answer: family history
Flashcard 748: _____ colorectal cancer is managed with a abdominal-perineal excision of rectum (APER)
Answer: Anal verge
Flashcard 749: _____ is the most common form of inherited colon cancer
Answer: Lynch syndrome
Flashcard 750: What type of oesophageal cancer is seen with a history of smoking and drinking? _____
Answer: Squamous cell carcinoma
Flashcard 751: What is the mainstay management of colon carcinoma? _____
Answer: Surgery
Flashcard 752: What are the most common types of oesophageal cancer? UK = _____ Developing world = Squamous cell carcinoma
Answer: Adenocarcionma (GORD/Barret's)
Flashcard 753: If the Faecal Immunochemical Test (FIT) is abnormal (↑ raised) then offer _____
Answer: a colonoscopy (2 week wait)
Flashcard 754: What type of oesophageal cancer is associated with long-standing GORD? _____
Answer: Adenocarcinoma
Flashcard 755: Odynophagia could be an insidious symptom of _____
Answer: oesophageal cancer
Flashcard 756: _____ cancer is the 4th most common type of cancer in the UK
Answer: Colorectal
Flashcard 757: Internal haemorrhoids can _____, external haemorrhoids can thrombose causing pain
Answer: strangulate
Flashcard 758: Colorectal cancers most commonly occur in the _____ decade of life
Answer: 7th
Flashcard 759: _____ is a rare autosommal dominant condition which leads to the formation of 100s of polyps by 30-40yrs that inevitably turn into colorectal carcionma
Answer: Familial Adenomatous Polposis (FAP)
Flashcard 760: What 2 hereditary conditions may be considered in colorectal carcinoma? _____
Answer: Lynch syndrome (HNPCC) & Familial Adenomatous Polyposis
Flashcard 761: Colorectal cancer red flag symptoms - Palpable _____ - Iron deficiency anaemia in men or non-menstruating women - Rectal bleeding & change in bowel habit for ≥ 6 weeks > 40 yrs - Rectal bleeding ≥ 6 weeks > 50 yrs
Answer: rectal mass
Flashcard 762: _____ haemorrhoids are graded: Grade I: protrudes into the anal canal but does not prolapse Grade II: prolapse on straining but reduces spontaneously Grade III: prolapse on straining and requires manual reduction Grade IV: prolapsed and cannot be reduced
Answer: Internal
Flashcard 763: What is the management of familial adenomatous polposis? _____
Answer: Total colectomy w/ileo-anal pouch
Flashcard 764: Rectal carcionma resection REQUIRES a _____ distal clearance margin
Answer: 2cm
Flashcard 765: The blood in haemorrhoids presents as _____ and is seen on toilet paper
Answer: bright red
Flashcard 766: The most common presentation of haemorrhoids is _____
Answer: painless, bright red bleeding
Flashcard 767: Colorectal carcinoma is most commonly beacuse of a _____ mutation
Answer: sporadic
Flashcard 768: Tenesmus can be a symptom of _____-sided colorectal carcinoma
Answer: left
Flashcard 769: Cancer more commonly occurs in the _____
Answer: colorectal
Flashcard 770: _____ of oesophagus = squamous cell carcionma Lower 1/3rds of oesophagus = adenocarcionma
Answer: Upper 2/3rds
Flashcard 771: Colorectal carcinoma is staged using the _____ scale or TNM
Answer: Duke's
Flashcard 772: _____ indicates left-sided colorectal cancer
Answer: Haematochezia
Flashcard 773: _____ risk factors: - Tobacco use - Alcohol consumption - Diet high in nitrosamines (processed meats) - Achalasia - Plummer-Vinsen syndrome
Answer: Squamous cell carcinoma
Flashcard 774: _____ colorectal cancer is managed with a anterior resection
Answer: Sigmoid, rectal
Flashcard 775: _____ of the oesophagus risk factors: - GORD - Barett's oesophagus - Obesity - Smoking - Alcohol
Answer: Adenocarcinoma
Flashcard 776: _____ is the most common type of oesophageal cancer, associated with GORD/Barret's oesophagus
Answer: Adenocarcinoma
Flashcard 777: Oesophgeal cancer may present with weight _____
Answer: loss
Flashcard 778: _____ is the most common/characteristic symptom of oesophgeal cancer
Answer: Progressive dysphagia
Flashcard 779: Haemorrhoids are also referred to as "_____"
Answer: piles
Flashcard 780: What diet increases the risk of colorectal cancer? _____
Answer: Diet rich in fat & meat, low in fibre (Western Lifestyle)
Flashcard 781: What is the management of benign colorectal adenomas? _____
Answer: Removal of polyps via colonoscopy
Flashcard 782: _____ are swollen, inflamed vascular cushions in the anal canal
Answer: Haemorrhoids
Flashcard 783: Colorectal cancers most commonly occur in the 1. _____ 2. Sigmoid 20% 3. Caecum + ascending colon 15%
Answer: Rectum 30%
Flashcard 784: Colorectal cancers initially start as benign _____
Answer: adenomas/polyps
Flashcard 785: _____ indicates right-sided colorectal cancer
Answer: Melena
Flashcard 786: What investigation is done for staging oesophageal cancer? _____
Answer: CT scan chest, abdomen, pelvis
Flashcard 787: What are the two main surgical options for rectal carcionma? _____
Answer: Anterior resection Abdomino-perineal excision of rectum (APER) Decision is made on the involvement of the anal sphincter → complex or very low tumours require APER
Flashcard 788: Colorectal cancer most commonly metastasises to the _____
Answer: liver
Flashcard 789: What is the management of oesophageal cancer? _____
Answer: Oesophagectomy +/- adjuvant chemotherapy
Flashcard 790: _____ haemorrhoids are painful
Answer: External
Flashcard 791: What is the investigation for locoregional staging of oesophageal cancer? _____
Answer: Endoscopic ultrasound
Flashcard 792: Whether colon carcioma surgery results in a stoma or _____ is an indiviudal case
Answer: anastomosis
Flashcard 793: Colorectal carcinoma should be staged using a _____
Answer: CT chest, abdomen, pelvis
Flashcard 794: Oesophageal cancer most commonly presents with _____, odynophagia, & weight loss/malnutrition
Answer: dysphagia
Flashcard 795: How can diverticular disease be diagnosed? _____
Answer: Colonoscopy, CT abdomen (IV contrast), or barium enema
Flashcard 796: What is the asymptomatic management of diverticular disease? _____
Answer: Increase fibre in diet
Flashcard 797: _____ describes the presence of diverticula that are inflamed/infected
Answer: Diverticulitis
Flashcard 798: What is the management of mild diverticulitis? _____
Answer: Antibiotics, analgesia, & liquid diet
Flashcard 799: What is the symptomatic management of diverticular disease? _____
Answer: Analgesia (paracetamol), & bulk-forming laxatives
Flashcard 800: Patients with _____ typically present with acute-onset of severe left lower quadrant pain, nausea & vomiting, change in bowel habit, fever
Answer: diverticulitis
Flashcard 801: Diverticulitis can be complicated with a _____ resulting in pneumaturia or faecaluria
Answer: colovesical fistula
Flashcard 802: What is the suspected pathophysiology of diverticula? _____
Answer: Lack of fibre means muscles in the colon have to work harder thus causing increased pressure which can result in out-pouchings
Flashcard 803: What is the next step in management for a patient being treated with RIPE therapy for TB for the past month that develops mild elevations in AST/ALT? _____
Answer: Continue with current treatment; monitor LFTs
Flashcard 804: _____ is the test of choice for diagnosing diverticulitis while it can be followed up with colonoscopy to assess the extent of diverticulitis and rule out malignancy
Answer: Abdominal CT with oral and IV contrast
Flashcard 805: Diverticular disease is primarily a disease of _____
Answer: the elderly
Flashcard 806: What tuberculosis drug is most commonly associated with liver injury? _____
Answer: Isoniazid
Flashcard 807: _____ describes the presence of diverticula without causing symptoms
Answer: Diverticulosis
Flashcard 808: _____ describes the presence of diverticula that causes symptoms
Answer: Diverticular disease
Flashcard 809: If acute diverticulitis is being treated at home (antibiotics, analgesia, & liquid diet) but does NOT get better in _____ then consider hospital admission
Answer: 72 hours
Flashcard 810: _____ & opioids should be avoided in diverticular disease because of increased risk of rupture
Answer: NSAIDs
Flashcard 811: 20% of patients with Diverticular disease will experience _____
Answer: acute diverticulitis at some stage
Flashcard 812: Diverticulum formation is caused by a _____ diet
Answer: low-fibre
Flashcard 813: What investigations must be AVOIDED in acute diverticulitis? _____
Answer: Colonoscopy or barium enema
Flashcard 814: What is the management of moderate to severe diverticulitis? _____
Answer: Hospitalisation!! → IV Antibiotics, analgesia, & IV fluids
Flashcard 815: What investigation of choice in diverticulitis? _____
Answer: CT scan w/oral & IV contrast
Flashcard 816: What classification criteria is used for acute diverticulitis? _____
Answer: Hinchey
Flashcard 817: Diverticula most commonly forms in the _____ thus presenting with lower abdominal (mostly left-sided) pain
Answer: sigmoid colon
Flashcard 818: On palpation of diverticulitis there is _____
Answer: a tender lower quadrant & in 20% of cases a palpable mass can be felt
Flashcard 819: Rifampin _____ cytochrome p450
Answer: induces
Flashcard 820: Diverticular disease can present with _____, altered bowel habit, & bloating
Answer: lower abdominal pain
Flashcard 821: _____ disease is notorious for concealing colon carcinoma
Answer: Diverticula
Flashcard 822: What is the management of pyloric stenosis? _____
Answer: Surgical excision (pyloromyotomy)
Flashcard 823: _____ is felt on physical examination of pyloric stenosis
Answer: Olive-shaped mass
Flashcard 824: What electrolyte disturbances are present in pyloric stenosis? _____ alkalosis
Answer: Hypochloraemic & hypokalaemic
Flashcard 825: Coeliac disease can present with anaemia Hb: _____ Vit B12: ↓ Ferritin: ↓
Answer: ↓
Flashcard 826: Pyloric stenosis generally occurs in infants up to _____ old
Answer: 2 months
Flashcard 827: Pyloric stenosis is more common in _____
Answer: males
Flashcard 828: Pyloric stenosis presents with projectile vomiting, _____, and dehydration
Answer: constipation
Flashcard 829: What is the likely diagnosis in an infant that presents with projectile, non-bilious emesis immediately after eating and an olive-shaped mass in the abdomen? _____
Answer: Pyloric stenosis
Flashcard 830: What is the management for coeliac disease? _____
Answer: Gluten-free diet
Flashcard 831: Children with coeliac disease usually present around _____ to 2 years old
Answer: 6 months
Flashcard 832: Gluten exposure in coeliac disease leads to _____ atrophy which causes malabsorption
Answer: villous
Flashcard 833: Pyloric stenosis is idiopathic but _____ increases ↑ the incidence risk
Answer: family history
Flashcard 834: What is the likely diagnosis in a patient who has symptoms of malabsorption with villous atrophy on duodenal biopsy? _____
Answer: Coeliac disease
Flashcard 835: Pyloric stenosis presents with _____ typically ~45 minutes after feeding
Answer: projectile vomiting
Flashcard 836: Pyloric stenosis presents with _____ emesis
Answer: non-bilious
Flashcard 837: What is the intial investigation for coeliac disease? _____
Answer: Serology of anti-tissue transglutaminase (TTG) antibodies (IgA)
Flashcard 838: Gluten should be introduced in the diet at least _____ before celiac disease serology tests & endoscopy
Answer: 6 weeks
Flashcard 839: Coeliac disease can be complicated with _____ because of malabsorption of vitamin D
Answer: osteoporosis
Flashcard 840: Coeliac disease peaks in _____ & 50-60yrs
Answer: childhood
Flashcard 841: Coeliac disease is associated with _____, type 1 diabetes & autoimmune hepatitis
Answer: dermatitis herpetiformis
Flashcard 842: _____ is an autoimmune disorder characterised by hypersensitivity to dietary gluten
Answer: Coeliac disease
Flashcard 843: _____ can be used to monitor gluten-free diet compliace for coeliac disease
Answer: Anti-tissue transglutaminase antibodies
Flashcard 844: What malabsorption disorder is associated with HLA-DQ2 and HLA-DQ8? _____
Answer: Coeliac disease
Flashcard 845: Patients with coeliac disease are offered _____ vaccination every 5 years
Answer: pneumococcal
Flashcard 846: What is the diagnostic/gold-standard investigation for coeliac disease? _____
Answer: Endoscopic intestinal (duodenal) biopsy
Flashcard 847: The prevalence rate of coeliac disease in the UK is _____%, but only 36% of people with the condition are currently clinically diagnosed
Answer: 1
Flashcard 848: Coeliac disease can be complicated with _____ because of folate deficiency
Answer: anaemia
Flashcard 849: _____ is a condition where the pylorus becomes narrower and presents with projectile vomiting
Answer: Pyloric stenosis
Flashcard 850: What investigation is done if coeliac serology testing suggest a possible diagnosis? _____
Answer: Endoscopic intestinal (duodenal) biopsy
Flashcard 851: _____ disease may present with many signs & symptoms: - Diarrhoea - Steatorrhoea - Abdominal pain - Bloating - Irritable bowel syndrome - Faltering growth - Prolonged fatigue - Mouth ulcers - Deficiencies - Dermatitis herpetiformis
Answer: Coeliac
Flashcard 852: What investigation is used to diagnose pyloric stenosis? _____
Answer: Ultrasound
Flashcard 853: Managment of acute alcoholic hepatitis: _____
Answer: Glucocorticoids (e.g. prednisolone)
Flashcard 854: What diagnostic test should be done for suspected alcoholic liver cirrhosis? _____
Answer: Transient elastography
Flashcard 855: _____ is used to determine is patients with alcoholic hepatitis would benefit from steroid (glucocorticoid) administration
Answer: Maddrey's Discriminant Function (DF)
Flashcard 856: An alcoholic with acute onset of abdominal pain, nausea, jaundice is most likely suffering from what condition? _____
Answer: Alcoholic hepatits
Flashcard 857: In children, the most common cause of intussusception is _____ (e.g. due to rotavirus or adenovirus)
Answer: lymphoid hyperplasia
Flashcard 858: Intussusception typically affects infants aged _____-12 months old
Answer: 3
Flashcard 859: What does ultrasound show with intussusception? _____
Answer: Target-like mass
Flashcard 860: Where in the GI tract does intussusception most commonly occur? _____
Answer: Ileocecal junction
Flashcard 861: What is the investigation of choice for intussusception? _____
Answer: Ultrasound
Flashcard 862: Investigations for alcoholic hepatitis: • _____ • LFTs
Answer: Gamma-GT (GGT)
Flashcard 863: Patients who are experiencing _____ may draw legs to their chest to ease the pain
Answer: intussusception
Flashcard 864: Intussusception results in compromised blood supply, which causes intermittent abdominal pain with "_____" stool
Answer: red-currant jelly
Flashcard 865: Intussusception is occasionally palpable as a "_____-shaped" or cylindrical mass in the right upper quadrant
Answer: sausage
Flashcard 866: What is the suspected diagnosis of a Child 3 mo - 3 yr, relief with knee-chest position and currant-jelly/bloody bowel movements? _____
Answer: Intussusception
Flashcard 867: _____ is when one segment of the bowel invaginates into another segment distal to it, most commonly around the ileo-caecal region
Answer: Intussusception
Flashcard 868: Patients' skin with intussusception may appear _____
Answer: pale
Flashcard 869: What is a late sign of intussusception? _____
Answer: Red-currant jelly stool
Flashcard 870: Intussusception affects _____ 3.5:1
Answer: boys
Flashcard 871: What is the first-line management of intussusception? _____
Answer: Reduction by air or contrast enema under radiological control
Flashcard 872: Thiamine deficiency is most commonly seen in _____
Answer: alcoholics
Flashcard 873: What is the first step in evaluation of biliary atresia? (after bilirubin) _____
Answer: Abdominal ultrasound
Flashcard 874: What is the first-line investigation for necrotising enterocolitis? _____
Answer: Abdominal X-ray
Flashcard 875: _____ is a rare infant liver condition in which the extrahepatic biliary ducts are obstructed or discontinued, causing bile stasis & progressive liver injury
Answer: Biliary atresia
Flashcard 876: Biliary atresia tends to onset _____
Answer: within the first 2-8 weeks
Flashcard 877: _____ presents with feeding intolerance, abdominal distention, vomiting + bloody diarrhoea
Answer: Necrotising enterocolitis
Flashcard 878: Patients with biliary atresia have high ↑ _____ bilirubin
Answer: conjugated
Flashcard 879: What is the treatment of necrotising enterocolitis? _____ ± Surgery
Answer: Bowel rest + parental nutrition Broad-spectrum IV antibiotics
Flashcard 880: Necrotising enterocolitis tends to occur _____ after birth
Answer: 3-10 days
Flashcard 881: What is the mangement of biliary atresia? _____
Answer: Surgical intervention - Kasai procedure
Flashcard 882: Neonates with _____ tend to present with jaundice, dark urine, & pale stools
Answer: biliary atresia
Flashcard 883: What is the cause of biliary atresia? _____
Answer: Idiopathic → it is theorised it involves an immune response triggered by infections or other factors
Flashcard 884: _____ should be excluded in any neonate with jaundice associated with pale stools
Answer: Biliary atresia
Flashcard 885: What demographic does necrotising enterocolitis usually occur in? _____
Answer: Preterm babies
Flashcard 886: _____ is intestine necrosis that can often lead to perforation in newborn babies
Answer: Necrotising enterocolitis
Flashcard 887: On physical examination of biliary atresia _____ can be palpated
Answer: hepatosplenomegaly
Flashcard 888: If surgery for biliary atresia is unsuccessful, a _____ may be needed in the first 2-5 years
Answer: liver transplant
Flashcard 889: What is the first-line treatment of constipation in children? _____
Answer: Movicol Paediatric Plain (polyethylene glycol 3350 + electrolytes)
Flashcard 890: What is the likely diagnosis in a preterm newborn that presents with vomiting, abdominal distention, rectal bleeding, and the X-ray below? _____
Answer: Necrotizing enterocolitis
Flashcard 891: What is seen on x-ray for necrotising enterocolitis? _____
Answer: Pneumatosis intestinalis + dilated loops
Flashcard 892: Children with appendicitis can present atypically with vague abdominal pain, _____, & may appear withdrawn
Answer: anorexia
Flashcard 893: _____ is among the most frequent acute surgical emergencies in children
Answer: Appendicitis
Keywords: Gastroenterology & Hepatology flashcards, medical flashcards, NEET PG preparation, USMLE Step 1 flashcards, Anki alternative, spaced repetition medical, OnCourse flashcards
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