4. Gastroenterology Flashcards
Drugs
Action of antacids
Action of H receptor antagonists
PPIs are gold standard
Oral diseases (3)
Dysphagia causes
Eliminate formed acid/neutralise stomach acid
Reduce acid production by preventing histamine activation of acid production - alternative pathways still operate (can be inhibited by gastrin and ACh)
OFG, ROU, lichen plans
Functional, dysmobility, due to external compression
GORD
Definition Complications (3) Causes (3) Signs and symptoms (4) How does Barrett's oesophagus occur GORD management (5) GORD drugs (2)
Repetitive heartburn and acid reflux
May cause ulcers, inflammation and metaplasia
Due to defective lower oesophageal sphincter, impaired gastric emptying, impaired lower clearing
Epigastric burning, dysphagia, GI bleeding, severe pain
Recurrent acid reflux in lower oesophagus –> Barrett’s (metaplastic change to gastric type mucosa in oesophageal lining)
Stop smoking, lose weight, avoid triggering activity, increase GI motility, increase gastric emptying
H blockers, PPI
PUD
Where can it occur Causes (4) Signs and symptoms (2) Investigations (4) Local complications (4) Management (5) Drug treatment
On any acid affected site
Due to high duodenal acid secretion (excessive acid –> oesophageal and duodenal ulcers), normal acid secretion (–> reduced productive layer/decreased mucus production), drugs (NSAIDs), H. pylori
Often none, epigastric burning (before/after meals)
Endoscopy, barium swallow, anaemia tests, H. pylori tests
Perforation, haemorrhage, stricture, malignancy
Stop smoking, small regular meals, ulcer healing drugs, lifestyle changes, surgery
Triple therapy - two antibiotics and one PPI
Coeliac disease
Definition Features (2) Causes What does gluten sensitive enteropathy involve Effects (2) Signs and symptoms (8) Investigations (2) Management What does management lead to (2)
Associated with dermatitis herpetiformis - what is this
a-gliaden gluten sensitivity (DQW2 gene)
Due to T-lymphocytes, villous atrophy
From iron/vitamin B12/folate/fat malabsorption
Subtotal villous atrophy of the jejunum
Growth failure, oral ulceration
Weight loss, lethargy, weak, abdominal pain/swelling, diarrhoea, aphthae/glossitis, dysphagia, steatorrhea
Jejunal biopsy, faecal fat
Gluten free diet
Jejunal atrophy reversal, increased well-being
Granular IgA depositions in skin and mucosa
Colonic carcinoma
Symptoms and signs (3)
Screening (5)
Causes (7)
Treatment (3)
Colonic cancer staging A-D (5yr survival %)
Often none, anaemia, PR bleed
FOB, barium enema, endoscopy, CT/MRI, CEA
Intestinal polyps (pedunculated/flat - bleed due to trauma), diet (reduced fibre and veg; increased fat and meat), alcohol, smoking, reduced exercise, p53 gene, UC
Surgery, chemotherapy, radiotherapy
A - submucosal (80%), B - muscularis (65%), C - lymph nodes (45%), D - liver (5%)
IBDs
Causes (4)
Investigations (3)
Drug treatment (2)
Features of OFG (5)
Immunological, psychological, smoking, genetics
Blood tests, endoscopy, faecal calprotectin
5-ASAs, NSAIDs
Lip swelling, angular cheilitis, cobblestoning, ulcers, full thickness gingivitis
Crohn’s
Definition of Crohn's Causes (2) Crohn's signs and symptoms (3) Usually affects (2) Complications (2) Treatment
Granulomatous inflammation/non-caseous granulomas
Food intolerance, persisting viral infection/immune activation
Colonic disease, small bowel disease (pain, obstruction, malabsorption), oral and anal disease
Proximal colon and terminal ileum. Skip lesions
Obstruction, abscess formation
Surgery to palliate symptoms and signs (stoma)
UC
Features (6)
Signs and symptoms (7)
Complications (4)
Treatment
Ulcers just in mucosa, continuous along colon, increased bleeding, no goblet cells, distortion of crypts, flat and vascular
Diarrhoea, abdominal pain, urgency, PR bleeding, bile motions, mucus, tenesmus
Carcinoma, perforation, bleeding, toxic megacolon
Stoma - colectomy is a cure
Differences between Crohn’s and UC (11 each)
Crohn’s - continuous, non-vascular, inflamed serosa
Rectum 50% involved, ileum 10% involved, 75% anal fissures
Mucosa cobbled and fissures present
Microscopically - trans mucosal, oedematous, granulomas
UC - non-continuous, vascular, serosa normal
Rectum 100% involved, ileum 30% involved, 25% anal fissures
Mucosa granulomatous and ulcers present
Microscopically - mucosal, vascular, mucosal abscesses
Jaundice
Definition Types (3) and definitions of each with examples (2) Features (3) Investigations (3) Management (4) Neonatal jaundice definition Neonatal jaundice causes (2) Risk of what with neonatal jaundice Neonatal jaundice treatment
Accumulation of bilirubin in skin, which can lead to pigmentation and itch
Pre-hepatic (increased haem load due to increased RBC breakdown - malaria, autoimmune disease)
(Intra-)hepatic (disruption of bilirubin processing and metabolism - primary biliary cirrhosis, hepatitis)
Post-hepatic (damage, inflammation, obstruction in bile duct –> gallbladder can’t secrete bile - primary biliary sclerosis, gallstones)
Urine/faecal excretion of conjugated bilirubin, pale stools, dark urine
Ultrasounds, X-ray, ERCP
Identify and treat cause, remove obstruction, prevent gallstone recurrence, prevent bile acid build-up/reabsorption from GIT
Increased haem breakdown
Birth trauma, ABO/Rh incompatibility –> poor liver funciton
Risk of kernicterus
Phototherapy
Gall bladder and pancreas
Diseases (2)
Usual population of gallstones sufferers (5)
Signs and symptoms (3)
Pancreas diseases (4) Causes of pancreatic diseases (7)
Acute cholecystitis, gallstones
Fat, forty, fertile, female, fair
Shoulder tip pain, URQ pain, pain when eating fatty foods
Pancreatitis, cystic fibrosis, chronic pancreatic disease, cancer
I GET SMASHED - gallstones, alcohol, trauma, steroids, mumps/infections, autoimmune, spider bites/scorpion stings
Cirrhosis
Definition
Features (3)
Causes (6)
Signs and symptoms (10)
Chronic liver scarring due to long-term/irreversible damage
Damage, fibrosis and regeneration
Alcohol, primary biliary sclerosis, chronic active hepatitis, autoimmune disease, cystic fibrosis, haemachromatosis
None - enlarged/reduced liver, acute bleed, oesophageal varies, jaundice, oedema, ascites, encephalopathy, spider nave, palmar erythema
Liver failure
Types (2) Liver function tests (2) Effects (5) Treatment (2) Liver functions (4) Liver failure complications (4)
Reduction in albumin leads to
Reduction in clotting factors leads to (2)
Definition and causes (2) of hepatitis
Loss of synthetic function (clotting factors), loss of metabolic function (drug breakdown, bilirubin conjugation)
INR, vitamin K test
Fluid retention, increased bleeding, portal hypertension, jaundice, can’t remove waste
Supportive, transplant
Bile acid synthesis and secretion, bilirubin conjugation, coagulation factors, detoxification
Malabsorption of fat/fat-soluble vitamins, jaundice, increased bleeding, encephalopathy
Increase in free drug in blood
Reduction in vitamin absorption, no clotting factors produced –> cycle
Liver inflammation due to viral infection, liver damage (alcohol)
GI infections
Causative agent
Detection (3)
Treatment (3)
Gastroenteritis
Definition
Signs and symptoms (11)
Type of infection (10)
H. pylori
Endoscopy and biopsy, breath test, serology
PPIs, antibiotics, bismuth salts
Non-specific term for various terms of GIT - diarrhoea, nausea, vomiting, abdominal pain
Viral - abdominal cramps, vomiting, profuse watery stools, myalgia, fever, headaches. Bacterial dysenetry - small volume stools, fever, tenesmus, blood mucoid stools, suprapubic pain
Invasive infection - organism enters mucosal cell, destroys them –> diarrhoea and bloody stools.
Enterotoxic syndrome - organism doesn’t enter mucosa but products enterotoxins, which act as chemical mediators –> fluid hypersecretion. Little tissue damage occurs
Norovirus
Structure
Transmission
Signs and symptoms (3)
Management
Non-enveloped single stranded RNA virus
Faecal-oral transmission
Abrupt onset of vomiting and watery diarrhoea, fever, abdominal pain
Correct fluid/electrolyte balance
