4. BAMS Gastroenterology Flashcards
What do antacids do
What do PPIs and H receptor antagonists do
How do H receptor antagonists do this
What is the disadvantage of using an H receptor antagonist and how is this disadvantage prevented
List 3 causes of dysphagia
List 2 oral consequences of GI disease
Neutralise stomach acid
Reduce acid secretion
Preventing histamine activation of acid production
Other pathways still operate, so limited drug benefit. These pathways are inhibited by gastrin or ACh
Functional, dysmobility or due to external compression
Direct (erosion) and indirect (nutritional deficiency)
GORD (Gastro-Oesophageal Reflux Disease)
What 2 things is GORD a combination of
List 3 reasons why GORD occurs
List 4 symptoms of GORD
List 3 complications of GORD
List 5 components of managing GORD
What is Barrett’s Oesophagus
How does this occur
Acid reflux and repetitive heartburn
Defective lower sphincter, impaired gastric emptying, impaired lower clearing
Epigastric burning, severe pain, dysphagia, GI bleeding
Metaplasia, inflammation, ulcer formation
Stop smoking, lose weight, medication (PPIs), increase GI motility and gastric emptying
Metaplastic change to gastric-type mucosa in oesophageal lining
Due to recurrent acid reflux in the lower part of the oesophagus
PUD (Peptic Ulcer Disease)
Where does PUD occur
List 4 causes of PUD
How is H. pylori treated
Name 2 investigations that could lead to a PUD diagnosis
List 4 local complications and one possible systemic complication of PUD
What are the 3 components in PUD treatment
On any acid affected site
H. pylori, drugs (NSAIDs, steroids), high duodenal acid secretion, normal gastric acid secretion (and reduced mucus production)
Triple therapy - two antibiotics and one PPI
Endoscopy, radiology (barium meal)
Local - perforation, stricture, haemorrhage/bleeding, malignancy. Systemic - anaemia
Stop smoking, small regular meals, lifestyle changes
Coeliac Disease
What is coeliac disease
List 3 components of coeliac disease presentation
What is the main reason coeliac disease occurs
What does gluten sensitivity enteropathy involve
List 5 symptoms of coeliac disease
List 2 investigations that could diagnose coeliac disease
What 3 things can adhering to a gluten free diet (coeliac disease treatment/management) lead to
A sensitivity to the a-gliaden component of gluten (found in barley, etc.)
Genetics (DEQ2 gene), T lymphocytes, villous atrophy
Usually results from a malabsorption of iron/vitamin B12/folate/fat
Subtotal villous atrophy of the jejunum
Weight loss, tiredness, weakness, abdominal pain, diarrhoea
Jejunal biopsy, blood test (measure haematinics)
Jejunal atrophy reversal, improved well-being, reduced risk of lymphoma
Colonic Carcinoma
List 2 (uncommon) symptoms associated
List 2 investigations that could make a diagnosis
List 7 causes of a colonic carcinoma
Describe the staging of colonic carcinoma (with 5yr survival rates - %)
What 3 ways can this be treated
Anaemia, PR bleeding
FOB, endoscopy
Intestinal polyps, diet, alcohol, smoking, reduced exercise, p53 gene, ulcerative colitis
A - submucosal (80%), B - muscular (65%), C - lymph nodes (45%), D - liver (5%)
Radiotherapy, chemotherapy, surgery
Crohn’s Disease
What is Crohn’s
What 3 things can it be caused by
List the presentation of Crohn’s
What 3 microscopic features does this disease have
List 2 symptoms of Crohn’s disease
List 2 complications of Crohn’s disease
What effect does a colectomy have
Granulomatous inflammation
Food intolerance, persisting viral infection, immune activation
Discontinuous, affects entire GIT, non-vascular, serosa inflamed, mucosa cobbled and fissures present rectum 50% involved, 75% anal fissures (skip lesions present), mainly affects proximal colon and terminal ileum (ileum 10% involved)
Granulomas, transmucosal, oedematous
Colonic disease, small bowel disease (pain, obstruction, malabsorption)
Obstruction, abscess formation
Palliates symptoms
Ulcerative Colitis (UC)
List the presentation of UC
What 3 microscopic features does this disease have
List 2 symptoms of UC
List 2 complications of UC
What effect does a colectomy have
Continuous, affects bowel/colon only, vascular, serosa normal (not inflamed), mucosa granulomatous and ulcers present, rectum always involved, 25% anal fissures, ileum 30% involved
Mucosal, vascular, mucosal abscesses
Diarrhoea, PR bleed, abdominal pain, bile motions
Bleeding, perforation, toxic megacolon, carcinoma
Cures the disease
IBDs (Inflammatory Bowel Diseases)
List 4 causes of IBDs
List 2 IBD investigations
List 6 differences between Crohn’s and UC
Psychological, immunological, smoking, genetic
Endoscopy, blood tests, faecal calprotectin
Crohn’s - discontinuous, affects entire GIT, non-vascular, serosa inflamed, mucosa cobbled and fissures present, colectomy palliates symptoms
UC - continuous, affects bowel/colon only, vascular, serosa normal, mucosa granulomatous and ulcers present, colectomy cures disease
Jaundice
What is jaundice
Describe the 3 types of jaundice, giving 2 examples of each
Give 2 features of jaundice
List 3 jaundice investigations
What does treatment involve
How is neonatal jaundice caused
What is there a risk of and what is this
How is neonatal jaundice treated
Excessive bilirubin - bilirubin accumulation in the skin
Pre-hepatic - excess bilirubin due to increased RBC breakdown. Malaria, anaemia, autoimmune disease
Intra-hepatic - failure of liver cells leads to failure to metabolise/conjugate bilirubin. Hepatitis, primary biliary cirrhosis, Gilberts syndrome
Post-hepatic - damage, inflammation, obstruction of bile duct prevents gall bladder from secreting bile. Primary biliary sclerosis, gallstones, pancreatic carcinoma
Pale stools, dark urine
ERCP, ultrasound, radiograph
Remove obstruction and treat cause (prevent gallstone recurrence, prevent bile acid build-up)
Birth trauma, incompatible blood types
Kernicterus (bilirubin-induced brain dysfunction)
Phototherapy
Gall Bladder
What is the function of the gall bladder
List 2 gall bladder diseases
List the features of the commonly affected population for one of these diseases
List 2 common gall bladder related disease symptoms
Secrete bile for breakdown of fat
Acute cholecystitis, gallstones
Female, forty, fat, fertile, fair
Abdominal (URQ) pain, pain when eating fatty foods
Pancreas
List 3 pancreatic diseases
List 4 causes of one of these diseases
Pancreatitis, cystic fibrosis, malignancy
Gallstones, alcohol, trauma, steroids, mumps (and other infections), autoimmune disease - I GET SMASHED
Liver Failure
In what 2 ways can liver failure be described and give one example of each type
What 5 things can liver failure lead to
In what ways can liver failure be managed/treated
List 4 liver functions and associated complications of liver failure
Loss of synthetic function (clotting factors) or loss of metabolic function (drug metabolism, detoxification)
Fluid retention, prolonged bleeding, portal hypertension, jaundice, inability to remove waste
Supportive, transplant
Production of coagulation factors - bleeding
Bilirubin conjugation - jaundice
Glucose haemostasis - hypoglycaemia
Detoxification - encephalopathy
Cirrhosis
What 3 components contribute to cirrhosis
List 5 causes of cirrhosis
List 4 symptoms of cirrhosis
Damage, fibrosis (scarring) and regeneration (reduced function) of the liver. Caused by irreversible (long-term) damage
Alcohol, chronic active hepatitis, cystic fibrosis, primary biliary sclerosis
Spider naevi, palmar erythema, jaundice, oedema and ascites
Hepatitis
What is hepatitis
What are 2 main causes of hepatitis
Inflammation of the liver
Alcohol, viral infection
GI Infections
What is the main causative agent associated with GI infection
What is gastroenteritis and list 4 ways it can present
List 2 features (each) of viral and bacterial gastroenteritis
Give the viral structure or norovirus
How is this transmitted
List 4 ways this presents
How is it treated
List 3 types of salmonella
How is this transmitted
List 4 ways this presents
How is it diagnosed
How is it treated
H. pylori
A term used to describe various pathologic states of the GIT. Diarrhoea, abdominal pain, nausea, vomiting
Viral - cramps, vomiting, diarrhoea, fever
Bacterial - small volume stools, suprapubic pain
Non-enveloped single stranded RNA virus
Faecal-oral transmission
Abrupt onset of diarrhoea, vomiting, abdominal pain, fever
Correct fluid/electrolyte balance
Gastroenteritis, enteric fever, bacteraemia
Faecal-oral transmission
Cramps, (bloody) diarrhoea, fever, vomiting
Stool sample
IV hydration and sometimes antibiotics
