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2A content- Sameera > 9. GI > Flashcards

9. GI Flashcards

1
Q

what is a mallory weiss tear and what can happen to this tear

A

Tear in oesophagus which can bleed

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2
Q

risk factor for mallory weiss tear

A

20-50 year old males

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3
Q

causes of mallory weiss tear (3)

A

things that increase intra-abdominal pressure (excessive vomiting, coughing and hiatus hernia)

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4
Q

signs and symptoms of mallory weiss tear (3)

A

Haematemesis (blood in vomit)
Melena (black stools due to older blood)
Systemic: Postural hypotension and dizziness

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5
Q

investigation for mallory weiss 1 and when should this be done

A

endoscopy within 24 hours

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6
Q

treatment steps for mallory weiss 3

A
  1. resuscitation (ABC)
  2. treat causes eg if alcohol is causing vomiting then stop alcohol intake
  3. clip or inject the tear with adrenaline to help it heal
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7
Q

key terminology for mallory weiss tear 3

A

‘Continuously retching’
‘Vomit with blood inside’
throwing up before blood

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8
Q

what r oesophageal varices

A

Enlarged veins protruding into the oesophagus

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9
Q

risk factors for oesophageal varicse 1

A

Past medical history of liver failure/ dysfunction

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10
Q

cause of oesophageal varices 1

A

Portal Hypertension

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11
Q

signs and symptoms of oesophageal varices 3

A
  1. Haematemesis (large volumes)
  2. Abdominal pain
  3. Shock, hypotension and pallor (due to blood loss)
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12
Q

investigations for oesophageal varices 2 (diagnosis, identify cause)

A

Diagnosis: endoscopy
doppler ultrasonography/ MRI to identify portal hypertension

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13
Q

treatment for oesophageal varices 3 (1st- 2 things, 2nd)

A

1st line: band ligation
Prophylactic antibiotic therapy
Transjugular intrahepatic portosystemic shunt (TIPS) if irresponsive to first line treatment

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14
Q

complication of oesophageal varices 1

A

Can lead to severe variceal bleeding

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15
Q

key terminology for oesophageal varices 1

A

coughing up A LOT of blood

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16
Q

what is achalasia (2)

A

Degeneration ganglions of myenteric plexus= LOS not relaxing properly

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17
Q

risk factor for achalasia 1

A

elderly

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18
Q

pathophysiology of achalasia 2

A
  1. LOS cannot relax
  2. This prevents food and drink going into the stomach
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19
Q

signs and symptoms of achalasia 3

A

Dysphagia- cannot swallow liquids OR solids
Heartburn (as contents of the stomach can travel up into the oesophagus and cannot go back down)
Regurgitation of food/ drink

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20
Q

1st line (and results) and GS for achalasia investigations

A

1st line: barium swallow test with a positive
Birds beak sign
GS: oesophageal manometry

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21
Q

what is a positive birds beak sign

A

dilated oesophagus and tight lower oesophageal sphincter

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22
Q

treatment for achalasia (3

A

Lifestyle changes: smaller and more frequent meals
nitrates/ CBB to relax LOS
Heller myotomy surgery (high success rate)

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23
Q

risk of treating achalasia

A

LOS too relaxed= risk of GORD

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24
Q

what is GORD and what does it stand for
what causes the reflux

A

LOS relaxation causes reflux of gastric contents into the oesophagus

Gastro-Oesophageal Reflux Disease

LOS relaxation

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25
Q

risk factors for GORD 3 and which sex is more likely to get this by how much and why

A

Increased intraabdominal pressure: obesity and pregnancy
Sliding Hiatus hernia (LOS slides up into chest)
Scleroderma (connective tissue disorder which scars the LOS)
LOS relaxants: Caffeine Alcohol
Males x2 risk than females (eostrogen is protective)

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26
Q

signs and symptoms 2 of GORD including 3 red flags and 3 extra-oesophageal signs GORD

A
  1. Heartburn (main symptom) which is exacerbated when lying down as reflux more easily occurs
  2. Dyspepsia
  3. Extra-oseophageal signs: cough, asthma, dental erosion (due to acid eroding teeth)
  4. Red flags: dysphagia, weight loss, haematemesis
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27
Q

investigations for GORD 2

A
  1. GS and diagnostic: 24 hour pH monitoring (abnormal if pH <4 more than 4% of the time)
  2. Endoscopy to look for Barrett’s, especially in those with chronic heartburn symptoms
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28
Q

treatment for GORD 2

A

1st line: PPI
Lifestyle changes: smaller meals, avoid food from 3 hours before bed

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29
Q

1 complication for GORD and show the disease pathway

A

Gastric adenocarcinoma
GORD-> barretts-> oesophageal adenocarcinoma

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30
Q

what is barretts oesophagus and where does this occur

A

Metaplasia from stratified squamous to simple columnar epithelium
Has to occur within 1cm of the gastro-oesophageal junction

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31
Q

epidemiology of barretts 3

A

middle aged
caucasian
males

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32
Q

investigation of barretts

A

Endoscopy with biopsy which should show metaplasia within 1cm of the GOJ

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33
Q

treatment for barretts 2

A

PPI
Regular Endoscopic surveillance (risk of cancer)

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34
Q

complication of barretts

A

Premalignant to oesophageal adenocarcinoma

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35
Q

what is gastritis

A

Inflammation of gastric mucosal lining

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36
Q

causes of gastritis 5

A

H. pylori
NSAIDs
alcohol
mucosal ischaemia
autoimmune (due to autoantibodies against gastric cells)
h, n, m, 2xa- HakuNa MaAatA

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37
Q

signs and symptoms of gastritis 5

A

Dyspepsia (indigestion)
Epigastric pain with diarrhoea
Nausea and vomiting
Early satiety

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38
Q

investigations for gastritis (1st line, GS)

A

For H Pylori suspected cause: stool antigen test and urea breath test
GS: endoscopy with biopsy

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39
Q

treatment for gastritis 3

A

For H. Pylori give triple therapy (1 PPI and 2 antibiotics eg omeprazole, clarithromycin and amoxicillin)
For autoimmune cause: IM Vit B12
For alcohol/ NSAID cause, cease them

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40
Q

3 complications of gastritis

A
  1. peptic ulcer disease
  2. gastric adenocarcinoma
  3. anaemia/ bleeding
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41
Q

name the disease pathway 3 involving gastritis

A

gastritis → peptic ulcer → gastric adenocarcinoma

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42
Q

define IBS 3

A

Chronic functional bowel disorder characterised by abdominal pain and change in bowel habits

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43
Q

3 risk factors for IBS

A

Stress/ anxiety
Female
Younger age (peak at 20-30 year olds)

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44
Q

cause of IBS 2

A

No single cause
contributions from food hypersensitivity

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45
Q

signs and symptoms of IBS 3

A

Abdominal pain and bloating relieved from defecation/ flatulence
Altered stool consistently and frequency
Symptoms worse postprandial

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46
Q

what is the general investigation aim for IBS

A

Process of exclusion of other conditions

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47
Q

4 investigations for IBS

A

Exclude coeliacs with serology (anti-tTG or anti-EMA)
Exclude IBD with faecal calprotectin
Exclude infections with ESR/CRP/ blood cultures
Exclude colorectal cancer with colonoscopy

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48
Q

diagnosis checklist for IBS 3

A

Diagnosis checklist=
1. recurrent abdominal pain for at least 1 day weekly for past 3 months
2. symptoms from 6 months ago
3. one of the following
-Symptoms relieved by defecation
-Change in bowel appearance
-Change in bowel frequency

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49
Q

3 categories of treatment for IBS

A

conservative, mild and severe

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50
Q

conservative treatment for IBS 2

A

Reassure patient
Advise to avoid trigger foods eg caffeine/ alcohol and short chain carbohydrate

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51
Q

mild treatment of IBS 2

A

Anti mobility eg Loperamide for diarrhoea
Laxatives eg Senna for constipation

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52
Q

severe treatment of IBS 3

A

Tricyclic antidepressants eg amitriptyline
CBT
GI referral

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53
Q

differentials of IBS 4

A

IBD
coeliacs
GI infection
lactose intolerance

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54
Q

what is coeliacs, what type of reaction is it and what is it mediated by

A

Autoimmune type 4 hypersensitivity to gluten (mediated by T cells)

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55
Q

risk factors for coeliacs 2

A

Other autoimmune conditions eg DM
Genetic (HLA-DQ2 or HLA-DQ8)

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56
Q

pathophysiology for coeliacs 5

A

Gluten broken down to gliadin
Gliadin binds to IgA= immune response
Autoantibodies anti-tTG and anti-EMI produced to this
These antibodies attack SI epithelial cells
This causes villous atrophy, crypt hyperplasia, intraepithelial lymphocytes

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57
Q

signs and symptoms of coeliacs 5

A
  1. Dermatitis herpetiformis (characteristic of coeliacs)- rash on knees, and elbows from IgA deposition near skin
  2. Diarrhoea
  3. Steatorrhea, Osteopenia, secondary anaemia and weight loss (due to malabsorption)
  4. Children= failure to thrive
  5. Angular stomatatitis (mouth ulcers)
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58
Q

investigations for coeliacs (1st, 2nd, GS)

A

1st line: serology
=anti-tTG antibodies (most specific)
AND Increase in total IgA (but risk of false +)
2nd line: serology
=anti-EMA antibodies (less reliable)
GS/ Diagnostic
=Duodenal biopsy showing crypt hyperplasia, villous atrophy and epithelial lymphocyte infiltration

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59
Q

treatment for coeliacs

A

gluten free diet for rest of life

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60
Q

compare the location of UC vs Crohns

A

UC- large colon
Crohns- anywhere in the GI tract

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61
Q

compare the pattern of inflammation UC vs Crohns

A

UC: continuous inflamed areas
CD: patches of inflammation called skip lesions

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62
Q

compare the location of pain UC vs Crohns

A

UC: typically in the lower left abdomen (uLcerative)
CD: typically in the lower right abdomen (cRohns)

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63
Q

compare the depth penetration in UC vs Crohns

A

UC: inflammation only of inner mucosal lining
CD: transmural inflammation (all layers)

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64
Q

compare bleeding in UC vs Crohns

A

UC: common during bowel movements, red stool
CD: uncommon in stool

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65
Q

what r the common risk factors for UC and Crohns 3

A

family history
NSAIDs
stress/ depression

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66
Q

unique risk factor to UC 1

A

HLA B27 gene

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67
Q

unique risk factor to Crohns 2

A

smoking
linked to NOD-2 mutation

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68
Q

what condition is smoking protective in

A

UC

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69
Q

signs and symptoms of UC 3

A

Lower left quadrant abdominal pain
Tenesmus
Blood mucosal watery diarrhoea

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70
Q

what is a extra-intestinal condition linked to UC 1

A

90% of UC patients have PSC

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71
Q

signs and symptoms of crohns 3

A

right lower quadrant abdominal pain
melena
signs of malabsorption: diarrhoea, weight loss, steatorrhea

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72
Q

extra intestinal signs of UC AND crohns 2

A

erythema nodosum and uveitis

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73
Q

what is a extra-intestinal condition linked to crohns 1

A

mouth ulcers

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74
Q

general investigation for IBD 4

A

inflammation: CRP/ESR/WCC
malabsorption: iron/ folate/ vit B
IBD marker: faecal calprotectin stool test (+ result)
GS: colonoscopy/ endoscopy with biopsy

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75
Q

what blood test differentiate between UC and crohns and what is the result for each

A

pANCA
+ for UC and - for Crohns

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76
Q

What is GS diagnostic for ulcerative colitis and 3 results

A

UC= colonoscopy with biopsy
-> continuous, leadpipe sign
-> mucosal inflammation
-> CRYPT HYPERPLASIA

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77
Q

What is GS diagnostic for crohns and 4 results

A

Crohns= endosocpy with biopsy
-> skip lesions
->cobblestoning
->transmural inflammation
->non- caseating granulomas

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78
Q

what is the treatment for mild IBD symptoms 2

A

Mesalazine and prednisolone

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79
Q

what is the treatment for mod/ severe IBD symptoms 2

A

Hydrocortisone
TNF alpha inhibitor eg infliximab

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80
Q

what is the GS treatment for UC and why is this not GS in crohns

A

Colectomy surgery (curative)
not curative in crohns

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81
Q

what maintains remission in UC vs crohns

A

UC= mesalazine
crohns= azathioprine

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82
Q

complication of UC 1

A

Toxic megacolon

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83
Q

complication of crohns 4

A

fistula
strictures
abscesses
small bowel obstruction
FASS

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84
Q

what is more common a small or large bowel obstruction?

A

small

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85
Q

causes and percentages of small bowel obstruction 3

A

75% adhesions (due to previous abdominal/ gynae surgeries)
10% hernias
Crohn’s strictures

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86
Q

causes and percentages of large bowel obstruction 3

A

90% malignancy ie colorectal cancer
5% sigmoid volvus (coffee bean appearance on abdominal X-ray)
Intussusception (bowel folds within itself in children)

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87
Q

signs and symptoms of small bowel obstruction

A

Colicky abdominal pain
Mild abdominal distension
Vomiting first then constipation
Tinkling bowel sounds

88
Q

signs and symptoms of large bowel obstruction

A

Continuous abdominal pain
Severe abdominal distension
Constipation first then vomiting
Absent bowel sounds

89
Q

investigations for obstruction of small, large and pseudo obstruction of the bowel (1st, GS)

A

1st=
-> abdominal X-ray
-> diagnosis: dilation of SI over 3cm, LI over 6cm or caecum over 9cm
GS:
-> CT abdomen and pelvis with contrast

90
Q

treatment for stable patients with small/ large bowel obstruction 3 and what is this management approach called

A

-> IV cannula for fluid resuscitation
-> NG feeding tube
-> analgesia, antiemetics, antibiotics
drip and suck

91
Q

treatment for unstable patients with small/ large bowel obstruction 2

A

surgery (resections/ laparotomy)- depends on cause and location

92
Q

what is pseudo obstruction

A

Colonic dilation with no mechanical obstruction

93
Q

causes of pseudo obstruction 2 and what is the main cause

A

Post operation (main cause)
neurological conditions eg MS/ parkinsons

94
Q

treatment for pseudo obstruction 2

A

Same as small and large bowel obstruction PLUS
IV neostigmine (relieved acute pseudo obstruction)

95
Q

complication of pseudoobstruction 2

A

Bowel ischaemia and perforation

96
Q

what is diarrhoea definition

A

3 or more watery stools passed a day

97
Q

classify acute, subacute and chronic time periods

A

Acute if under 14 days
Subacute if 14-28 days
Chronic if over 28 days

98
Q

4 general causes of diarrhoea

A
  1. IBD/IBS
  2. coeliac
  3. HYPERTHRYOIDISM
  4. infection
99
Q

what 3 subclassifications in diarrhoea caused by infection and give examples for each (2, 5,1)

A

viral: rotavirus in kids and nororvirus in adults
bacterial: C. diff, C. jejuni, E.coli, shigella, salmonella
helminth (giardia lambda)

100
Q

main cause of diarrhoea

A

viruses

101
Q

signs and symptoms of diarrhoea 3

A

vomiting
abdominal cramps
watery stools 3+ times a day

102
Q

what suggests a bacterial cause of diarrhoea 2

A

dysentery (blood in diarrhoea)
previous antibiotic use= campylobacter

103
Q

what suggests there is a infectious cause behind diarrhoea 1

A

acute history

104
Q

what suggests a viral cause for diarrhoea 4

A

muscle pain, fatigue, headache, fever (all complications a nurse tells u before a vaccination)

105
Q

what three main tests can be done for diarrhoea

A

blood tests
PCR
stool culture

106
Q

what is PCR test for in diarrhoea testing for 3

A

for viruses, C. diff or campylobacter

107
Q

what is stool culture test for diarrhoea testing for 2

A

bacteria or parasites

108
Q

what can be investigated in blood tests for diarrhoea and what do they point towards (3)

A

-> increased ESR/ CRP= infectious cause
-> increased eosinophils= parasitic
-> increased ESR/CRP and anaemia= Crohns, UC, cancer

109
Q

treatment for diarrhoea 3 step approach

A
  1. Oral rehydration
  2. Treat underlying cause
  3. Medicine for symptoms:
    -> antiemetics eg metoclopramide
    -> antimotility eg loperamide
110
Q

what two conditions does bowel ischaemia involve and which is more common out of the two

A

ischaemic colitis and mesenteric ischaemia

ischaemic colitis

111
Q

what is ischaemic colitis and what does this typically affect and why

A

Ischaemia of colonic arterial supply due to hypoperfusion
splenic flexure as this is most distal

112
Q

signs and symptoms of ischaemic colitis 3

A

Left lower quadrant abdominal pain (colicky, worse postprandial)
Bright blood stool
Signs of hypovolemic shock (pallor, weak and rapid pulse)

113
Q

investigations for ischaemic colitis 1st, 2nd GS and what is the condition for the GS

A

1st line: General investigation with physical exam and rule out causes with full bloods, ECG and LFT
2nd line: CT contrast or angiography
Gold standard: Colonoscopy and biopsy (after patient has recovered to prevent poor healing and stricture formation)

114
Q

treatment for ischaemic colitis if symptomatic 2 and if gangrenous 1

A

If symptomatic: antibiotic prophylaxis and rehydration
If gangrenous (infection): surgery

115
Q

complications of bowel ischaemia 2 and what can they lead to 1 each

A

perforation which can lead to spontaneous bacterial peritonitis
Strictures (narrowing) which can cause obstruction

116
Q

what is mesenteric ischaemia
what r the 2 types

A

Ischemia due to narrowed/ blocked GI blood vessels supplying the small bowel
Can be acute (like an abdominal MI- emergency) or chronic (like abdominal angina)

117
Q

risk factors for bowel ischaemia 3 and one specific to acute mesenteric ischaemia

A

Same for CV and atherosclerosis eg hypertension, obesity, DM
acute mesenteric isch= A Fib

118
Q

triad of signs and symptoms of mesenteric ischaemia 3

A

-> central or right iliac fossa severe pain
-> no abdominal signs on exam eg guarding/ rebound tenderness
-> rapid hypovolemic shock

119
Q

what r the two characteristics of upper IG bleeds

A

haematemesis
melena

120
Q

what r the 2 characteristic of lower GI bleeds

A

haematochezia
dystentery

121
Q

what r the 7 red flags for GI and what do they point towards

A

point to cancer
ALARMS55 (anaemia, loss of weight, anorexia, recent symptom onset, melena, dySphagia, older than 55)

122
Q

what is the investigation for dysphagia

A

endoscopy

123
Q

what is the investigation for bleeds 2

A

endocsopy/ colonoscopy

124
Q

what is the investigation for anal issues

A

DRE

125
Q

what is appendicitis

A

inflammation of the appendix

126
Q

what r the causes of appendicitis 2

A

infectious microorganisms
blockage of appenditicits

127
Q

pathophysiology of appendicitis (3 steps) and what can this do (3)

A

obstruction
causes bacterial growth
inflammation of appendix
inflammation can press on nerves, blood vessels and stop secretions

128
Q

signs and symptoms of appendicitis 3

A

umbilical pain which localises as right iliac fossa pain
nausea and vomiting
pyrexia

129
Q

test investigations for appendicitis (3)

A

blood test: high WCC, ESR, CRP
CT abdo and pelvis GS
pregnancy test to rule out ectopic pregnancy

130
Q

physical exam investigations for appendicitis 5

A
  1. Roving’s sign (palpation on the left iliac fossa causes pain in the right iliac fossa)
  2. psoas sign (right iliac pain on right hip extension)
  3. obturator sign (right iliac iliac pain on right hip flexion and internal rotation)
  4. guarding
  5. rebound tenderness
131
Q

treatment for appendicitis 2 and how is this done 2

A

antibiotics
appendectomy
laparoscopic or open

132
Q

define diverticulum

A

outpouching of the colon wall

133
Q

what is diverticula

A

plural of diverticulum

134
Q

what is diverticular disease

A

diverticula with symptoms

135
Q

what is diverticulosis

A

diverticula WITHOUT symptoms

136
Q

what is diverticulitis

A

when diverticula become inflammed

137
Q

explain the pathophysiology of diverticulitis 2 steps

A
  1. high pressure in colon/ weak wall= diverticula formed
  2. inflammation if bacteria/ faecal matter gathers in diverticula
138
Q

risk factors for diverticular disease 4

A

NSAIDs
obesity
constipation
ageing

139
Q

where do diverculas typically form

A

sigmoid colon

140
Q

signs and symptoms of diverticular disease 3

A

left lower quadrant pain
constipation
fresh rectal bleeding
divertiCuLaR
constipation, lower left quadrant pain, rectal bleeding (haematochezia)

141
Q

complication of appendicitis 2

A

SBO if rupture
periappendiceal abscess

142
Q

what is meckels diverticulum and what type of patients does it affect

A

paedtriatrics
failure of obliteraiton of vitelline duct

143
Q

investigation for diverticular disease (GS)

A

CT abdomen and pelvis with contract GS

144
Q

treatment for diverticulosis 1

A

watch and wait approach

145
Q

treatment for diverticular disease (2, GS)

A

bulk forming laxative eg isphagula husk and antibiotics
GS= surgery

146
Q

treatment for diverticulitis 3

A

co-amoxiclav
paracetamol
IV fluid

147
Q

what type of gram bacteria is H pylori

A

gram - bacteria

148
Q

what does H pylori cause 3

A

peptic ulcer disease
gastric adenocarcinomas
gastritis

149
Q

investigations for H pylori (1st line, GS) and what is the condition for the 1st line

A

1 st line- urea breath test/ stool antigen tests
Stop PPI for 2 weeks before testing
GS- Biopsy

150
Q

what is treatment for H pylori 3

A

clarithromycin
amoxicillin
omeprazole

151
Q

alternative to amoxicillin in H pylori triple treatment 1

A

metronidazole

152
Q

what r the two types of oesophageal cancer and where do they affect

A

Adenocarcinoma- lower 1/3 of the oesophagus
Squamous cell carcinoma- upper 2/3 of the oesophagus

153
Q

cause of oesophageal adenocarcinoma 1

A

Barret’s oesophagus metaplasia

154
Q

cause of oesophageal squamous cell carcinoma 2

A

smoking
alcohol

155
Q

signs and symptoms of oesophageal cancer

A

anaemia
loss of weight
anorexia
recent symptoms
melena
swallowing is PROGRESSIVELY worse (solids to liquids)

156
Q

differential to oesophageal cancer 1 and how to tell them apart

A

achalasia- achalasia unable to swallow both liquids and solids, cancer is progressive so unable to swallow solids then liquids

157
Q

investigation for oesophageal cancer (GS, staging)

A

GS- endoscopy + biopsy (w/barium)
CT for staging (TNM)

158
Q

treatment for oesophageal cancer (earlier and later stage)

A

earlier: Surgical resection w/radio/chemotherapy

Later stages- palliative

159
Q

what type of cancers r most gastric cancers

A

adenocarcinomas

160
Q

what r the two types of gastric carcinomas and explain three differences between the two

A

T1 and 2
T1- well differentiated better prognosis- Tubular cells on histology
T2- poorly differentiated worse prognosis- Signet ring cells

161
Q

causes of gastric carcinomas 4

A

H. pylori
Smoking
CDH-1 (Tumour suppressor gene)
Autoimmune chronic gastritis (pernicious anaemia)

162
Q

signs and symptoms of gastric carcinomas 3

A

Severe epigastric pain (worse than gastritis)
Cancer signs- Weight loss, TATT
ALARMS- progressive dysphagia

163
Q

what r the metastases signs associated with gastric carcinoma 4

A

Jaundice – liver met
Krukenberg tumour- ovarian met
Lymph node met:
- Virchows node- supraclavicular
- Sister Mary Joseph node- umbilical

164
Q

investigation for gastric carcinoma (2)

A

Gastroscopy + Biopsy
CT for staging (TNM)

165
Q

treatment for gastric carcinoma

A

Surgery and chemo

166
Q

what is the requirement for 2 week GI endoscopy referral 2

A

dysphagia
or over 55 with weight loss and 1/3
1. reflux
2. dyspepsia
3. abdominal pain

167
Q

how common r small bowel carcinomas

A

Rare

168
Q

risk factor of small bowel carcinomas

A

Chronic SI disease e.g. Crohn’s, Coeliac

169
Q

investigation 2 and treatment of small bowel carcinoma 2

A

investigation: gastroscopy + biopsy and CT for staging
treatment: surgery and chemo
same as gastric cancer

170
Q

what is the pathophysiology of large bowel cancer 2

A
  1. spontaneous benign adenomas form
  2. these are precursors- develop into cancers
171
Q

two conditions that increase risk of polyps

A

FAP- familial adenomatous polyposis
HNPCC lynch syndrome- hereditary non-polyposis colorectal cancer

172
Q

what is the gene mutation in FAP and HNPCC

A

FAP: APC gene mutation
HNPCC: MLH 1 gene mutation

173
Q

how does FAP and HNPCC cause large bowel cancer

A

FAP: causes 1000s of duodenal polyps to form which inevitably become cancerous
HNPCC: rapidly increases progression of adenoma and makes it cancernous

174
Q

risk factors for large bowel adenoma 5

A

Gene mutations
Having polyps
Alcohol
smoking
UC
PAGSU (like DK)

175
Q

where does large bowel cancer commonly metastasise to 2

A

liver and lungs

176
Q

signs and symptoms of large bowel cancer 3

A

LLQ pain
Blood mucous stools (fresh blood, closer to anus)
Tenesmus
same as UC

177
Q

investigations into large bowel cancer (1st, GS, what happens if 1st comes back +)

A

FIT TEST (Faecal occult - Screening)- faecal immunochemical test
GS- Colonoscopy + Biopsy
Patients with a positive FIT or suspected colorectal cancer referred for a colonoscopy within 2 weeks

178
Q

treatment for large bowel cancer 3

A

Surgical resection + chemo/radiotherapy

179
Q

what r the 2 types of peptic ulcers classified under peptic ulcer disease, which is most common

A

gastric and duodenal
most common= duodenal

180
Q

where r gastric ulcers found 1

A

Lesser curvature of the stomach

181
Q

4 causes of gastric and duodenal ulcer

A

Gastritis
H. pylori
NSAIDs
Zollinger-Ellison syndrome- tumour that secretes high amounts of gastrin leading to hypersecretion of HCL

182
Q

signs and symptoms of gastric ulcers 4

A

Epigastric pain- WORSE ON EATING
Dyspepsia
Perforation of the L. gastric artery- melaena and haematemesis

183
Q

what r the investigations for gastric and duodenal ulcers

A
  1. if red flags then GS= urgent endoscopy with biopsy
  2. if no red flags then H pylori test (urea breath and stool antigen)
184
Q

what is the condition for testing for H pylori with stool antigen/ urea breath test and why

A

has to be off PPI for 2 weeks prior to reduce false positive

185
Q

treatment for gastric and duodenal ulcers 1 and what is the specific treatment if peptic ulcer disease is found 1

A
  1. treat causes eg stop NSAIDs/ H pylori treatment
  2. if peptic ulcer disease found then rescope 6-8 weeks later
186
Q

acute complication of gastric ulcer

A

Bleeding due to ruptured left Gastric artery

187
Q

where r duodenal ulcers found 2

A

D1/D2 posterior wall

188
Q

signs and symptoms of duodenal ulcers 4

A

Epigastric pain- BETTER AFTER EATING
Dyspepsia
Perforation of gastroduodenal artery- melaena and haematochezia

189
Q

what r haemorrhoids

A

enlarged veins around anus

190
Q

3 causes of haemorrhoids and main cause

A

MC: constipation
anal sex
pregnancy

191
Q

grades of haemorrhoids 4

A
  1. No prolapse
  2. Prolapse when straining and return on relaxation
  3. Prolapse when straining and can be manually pushed back in
  4. Prolapse permanently
192
Q

signs and symptoms of haemorrhoids 2

A

haematachezia
Puritis anus

193
Q

investigations of haemorrhoids for internal and external prolapses (1,1)

A

External prolapsed- PR
Internal prolapsed- proctoscopy

194
Q

conservative treatment for haemorrhoids 4

A

topical treatment
IV fluid, fibre and laxatives for constipation

195
Q

haemorrhoid treatment 1st and 2nd grade 1

A

rubber band ligation

196
Q

haemorrhoid treatment 3rd and 4th grade

A

haemorrhoidectomy

197
Q

what is a perianal abscess

A

Infection in anorectal tissue

198
Q

causes of perianal abscess 3

A

anal trauma (anal sex-> oral gland infection)
Crohn’s
ANAL fistula

199
Q

signs and symptoms of perianal abscess 2

A

Perianal pain
pus in stool

200
Q

treatment for perianal abscess 2

A

Surgical removal and drainage

201
Q

what is anal fistula

A

Abnormal ‘passage’ form between the epithelial surface of the anal canal and skin

202
Q

causes of anal fistula 2

A

Perianal abscesses
Crohn’s disease

203
Q

signs and symptoms of anal fistula 3

A

Throbbing pain worse on sitting
Blood mucous in stool
Puritis

204
Q

treatment for anal fistula 2

A

Surgery

Treat with antibiotics if infected

205
Q

what is an anal fissure

A

Tear in anal skin lining below dentate line

206
Q

causes of anal fissure3

A

Constipation (MC)
Anal trauma
Crohn’s and UC

207
Q

signs and symptoms of anal fissure 2

A

Extreme pain on defecation

Anal bleeding

208
Q

treatment for anal fissure 2

A

Stool softening- increase Fibre and fluids

209
Q

what is a pilonidal sinus/ abscess- pathophysiology

A

Hair follicles get stuck in natal cleft (bumcrack) which form sinuses and can get infected to form abscesses

210
Q

risk factor for pilonidal sinus/ abscess 1

A

hairy people

211
Q

signs and symptoms of pilonidal sinus/ abscess

A

swollen pus filled smelly abscess on bumcrack
viable on exam

212
Q

treatment for pilonidal sinus/ abscess 2

A

Surgery and hygiene advice

213
Q

what is Pseudomembranous colitis

A

Inflammation of the colon due to overgrowth of C. difficile and a recent history of antibiotic use

214
Q

causes of Pseudomembranous colitis 4

A

 Clindamycin (see linda my sin)
 CIPROFLOXACIN
 Cephalosporins
 Penicillin

215
Q

pathophysiology of Pseudomembranous colitis

A

Normal GIT flora is killed by Abx and C. difficile is replaced

216
Q

signs and symptoms of Pseudomembranous colitis 1

A

Severe infectious diarrhoea

217
Q

treatment of pseudomembranous colitis 3

A

Stop using C’s Abx
Give metronidazole, vancomycin

2A content- Sameera (21 decks)

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