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Yr 4 - CCC > Corrections - GI > Flashcards

Corrections - GI Flashcards

1
Q

FAP vs Gardners syndrome?

A

Gardner syndrome is a variant of FAP.

Like in FAP, people with Gardner syndrome develop multiple adenomatous colon polyps, but in addition, they also develop other tumors outside the GI organs, e.g. skull osteoma, thyroid cancer, epidermoid cysts.

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2
Q

In which IBD are increased goblet cells seen?

A

Crohn’s disease

These are simple columnar goblet shaped epithelial cells

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3
Q

In which IBD are crypt abscesses seen?

A

UC

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4
Q

What type of anaemia can Coeliac disease cause?

A

Normocytic anaemia - as coeliac disease impairs absorption of minerals e.g. iron, vitamin B12

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5
Q

What stools can be seen in Coeliac disease?

A

Greasy and foul-smelling (indicate steatorrhoea due to malabsorption of fat)

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6
Q

What drug is used for the prophylaxis of oesophageal bleeding?

A

Non-cardioselective beta blocker e.g. propanolol

These cause vasodilation in these engorged vessels and reduced heart rate which lowers the BP in the variceal veins and reduces the risk of rupture.

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7
Q

What drug is given to help control variceal bleeding?

A

Terlipressin

This is a synthetic analogue of vasopressin that acts as a vasoconstrictor. It reduces portal venous pressure by causing splanchnic vasoconstriction, which helps control variceal bleeding.

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8
Q

Presentation of mesenteric ischaemia?

A
  • sudden abrupt onset of abdominal pain
  • nausea & vomiting
  • diarrhoea (may be bloody)
  • may have risk factors e.g. AF
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9
Q

What is an AKI?

A

Acute kidney injury (AKI) refers to a rapid drop in kidney function

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10
Q

Next investigation in high grade dysplasia on biopsy in Barrett’s oesophagus?

A

Endoscopic intervention

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11
Q

What type of liver disease is associated with sudden weight loss?

A

Non-alcoholic fatty liver disease

This is particularly relevant in the context of obese patients with metabolic syndrome undergoing bariatric surgery and sudden weight fluctuations.

Weight loss triggers catabolism of peripheral adipose reserves and importation of toxic lipids to the liver which trigger steatosis, inflammation, and hepatocyte cell death.

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12
Q

Recommendation for immunisation in Coeliac disease?

A

Recommendation that everyone with coeliac is vaccinated against pneumococcal infection and has booster every 5 years (as risk of hyposplenism)

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13
Q

What is SAAG?

A

SAAG = serum-ascites albumin gradient.

A physiological clinical diagnostic tool for the evaluation of ascites.

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14
Q

What does an increased SAAG indicate?

A

An increased SAAG (> 1.1 gm/dL) value indicates the presence of portal hypertension.

This is because increased hydrostatic pressure forces fluid out of the vascular spaces, concentrating serum albumin.

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15
Q

Main cause of a high SAAG ascites?

A

Liver cirrhosis

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16
Q

Management of severe alcoholic hepatitis?

A

Corticosteroids

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17
Q

Features of vitamin C deficiency?

A

Essential for collagen synthesis so can lead to:

1) Impaired wound healing

2) Gum disease

3) Pale conjunctivae

4) Other connective tissue abnormalities

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18
Q

Management of severe flare of UC?

A

IV corticosteroids

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19
Q

If the AST:ALT ratio is greater than 2, what does this suggest?

A

Alcoholic hepatitis

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20
Q

If the AST:ALT ratio is less than 1, what does this suggest?

A

NAFLD

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21
Q

Patient with obesity and abnormal LFTs, what condition do you think?

A

NAFLD

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22
Q

Management of suspected upper GI bleed?

A

OGD within 24 hours

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23
Q

What medication can reduce mortality in cirrhotic patients with GI bleeding?

A

Antibiotic prophylaxis, usually quinolones (in addition to terlipressin)

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24
Q

What is a pharyngeal pouch?

A

Where a small sac forms in throat just above oesophagus

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25
Q

Symptoms of pharyngeal pouch?

A

1) Dysphagia

2) Halitosis (bad breath): due to bacterial breakdown of retained food

3) Nocturnal coughing: due to aspiration of trapped food in pouch, may cause aspiration pneumonia

N.B. these symptoms are often intermittent (i.e. won’t cause significant weight loss)

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26
Q

What is a benign oesophageal stricture?

A

Typically results from long standing acid reflux causing scarring and narrowing of lower oesophagus

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27
Q

Presentation of oesophageal stricture?

A

Progressive dysphagia (from liquids to solids)

History of longstanding heartburn

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28
Q

1st line therapy in C. diff infection?

A

Oral vancomycin for 10 days

Also current antibiotic therapy should be reviewed and antibiotics stopped if possible.

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29
Q

2nd line therapy in C. diff infection?

A

oral fidaxomicin

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30
Q

3rd line therapy in C. diff infection/severe C. diff infection?

A

oral vancomycin +/- IV metronidazole

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31
Q

What should be prescribed in all patients with suspected hepatic encephalopathy?

A

Lactulose

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32
Q

Why should lactulose be prescribed in all patients with suspected hepatic encephalopathy?

A

Lactulose works to inhibit production of ammonia in intestine

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33
Q

Features of oesophageal carcinoma?

A

1) Progressive dysphagia

2) Weight loss

3) May be hoarseness of voice due to laryngeal nerve damage

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34
Q

What is considered in C. diff cases not responding to oral vancomycin?

A

Oral fidaxomicin (particularly for recurent cases within 12 weeks of symptom resolution)

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35
Q

What is the only test recommended for H. pylori post-eradication therapy?

A

Urea breath test

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36
Q

Most appropriate blood test for coeliac disease diagnosis?

A

Total IgA + IgA tTG

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37
Q

Who should coeliac testing be offered to?

A

1) persistent unexplained abdo or GI symptoms

2) faltering growth

3) prolonged fatigue

4) unexpected weight loss

5) severe or persistent mouth ulcers

6) unexplained iron, vit B12 or folate deficiency

7) T1D at diagnosis

8) autoimmune thyroid disease at diagnosis

9) IBS (in adults)

10) 1st degree relatives of people with coeliac

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38
Q

What is spontaneous bacterial peritonitis (SBP)?

A

Ascitic fluid infection without an evident treatable intra-abdominal source.

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39
Q

Who does SBP typically occur in?

A

Those with known cirrhosis and ascites, commonly as a result of alcoholic liver disease, hep B, hep C, and NAFLD.

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40
Q

Presentation of SBP?

A
  • known liver disease
  • fever
  • abdo tenderness
  • vomiting
  • altered mental state
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41
Q

Investigations of choice in primary sclerosing cholangitis?

A

ERCP/MRCP

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42
Q

Give some causes of abdo pain

A

1) Peptic ulcer disease

2) Appendicitis

3) Acute pancreatitis

4) Biliary colic

5) Acute cholecystitis

6) Diverticulitis

7) Abominal aortic aneurysm

8) Intestinal obstruction

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43
Q

Are duodenal or gastric ulcers more common?

A

Duodenal

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44
Q

Location of duodenal ulcer pain?

A

Epigastric

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45
Q

describe impact of eating on epigastric pain in:
a) duodenal ulcer
b) gastric ulcer

A

a) epigastric pain relieved by eating
b) epigastric pain worsened by eating

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46
Q

What other features may be seen in peptic ulcer disease?

A

Features of upper gastrointestinal haemorrhage may be seen (haematemesis, melena etc)

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47
Q

Location of pain in appendicitis?

A

Pain initial in the central abdomen before localising to the right iliac fossa

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48
Q

Other possible findings in appendicitis?

A

1) Anorexia is common

2) Tachycardia, low-grade pyrexia, tenderness in RIF

3) Rovsing’s sign: more pain in RIF than LIF when palpating LIF

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49
Q

Most 2 common causes of acute pancreatitis?

A

1) Alcohol
2) Gallstones

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50
Q

Describe pain in acute pancreatitis

A

Severe epigastric pain

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51
Q

Other findings in acute pancreatitis?

A
  • Vomiting is common
  • Examination may reveal tenderness, ileus and low-grade fever
  • Periumbilical discolouration (Cullen’s sign) and flank discolouration (Grey-Turner’s sign) is described but rare
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52
Q

Describe pain in biliary colic

A

Pain in the RUQ radiating to the back and interscapular region, may be following a fatty meal.

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53
Q

Other features of biliary colic?

A
  • Obstructive jaundice may cause pale stools and dark urine
  • Afebrile
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54
Q

Typical patient with biliary colic?

A

female, forties, fat and fair although this is obviously a generalisation

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55
Q

Pain in acute cholecystitis?

A

Continuous RUQ pain

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56
Q

Other features of acute cholecystitis?

A
  • History of gallstones
  • Fever, raised inflammatory markers and white cells
  • Murphy’s sign positive (arrest of inspiration on palpation of the RUQ)
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57
Q

Describe pain in diverticulitis

A

Colicky pain typically in the LLQ

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58
Q

Other features of divertiulitis?

A

Fever, raised inflammatory markers and white cells

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59
Q

Describe pain in an AAA

A

Severe central abdominal pain radiating to the back

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60
Q

Clinical features of acute upper GI bleed?

A

1) haematemesis

2) melena

3) raised urea

4) features associated with a particular diagnosis e,g, oesophageal varices: stigmata of chronic liver disease, peptic ulcer disease: abdominal pain

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61
Q

Description of haematemesis in acute upper GI bleed?

A

often bright red but may sometimes be described as ‘coffee gound’

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62
Q

Description of melena in acute upper GI bleed?

A

typically black and ‘tarry’

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63
Q

Cause of raised urea in upper GI bleed?

A

a raised urea may be seen due to the ‘protein meal’ of the blood

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64
Q

2 most common causes of upper GI bleed?

A

1) oesophageal varices
2) peptic ulcer disease

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65
Q

Give 4 oesophageal causes of upper GI bleed

A

1) Oesophageal varices
2) Oesophagitis
3) Cancer
4) Mallory Weiss tear

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66
Q

Haematemesis & melena in oesophageal varices vs oesphagitis vs Mallory Weiss tear?

A

Oesophageal varices:
- Usually a large volume of fresh blood.
- Swallowed blood may cause melena
- Often associated with haemodynamic compromise.

Oesophagitis:
- Small volume of fresh blood, often streaking vomit
- Melena rare
- Often GORD type history

Mallory Weiss:
- Typically brisk small to moderate volume of bright red blood following a bout of repeated vomiting.
- Melena rare

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67
Q

Who are oesophageal varices more common in?

A

Liver disease (e.g. advanced cirrhosis)

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68
Q

Who are Mallory Weiss tears more common in?

A

Alcoholics, bulimia, cyclic vomiting syndrome (CVS)

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69
Q

How would a bleeding gastric ulcer typically present?

A

Small low volume bleeds are more common so would tend to present as iron deficiency anaemia.

(Erosion into a significant vessel may produce considerable haemorrhage and haematemesis)

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70
Q

Glasgow-Blatchford score vs Rockall score?

A

Glasgow-Blatchford score at first assessment: helps clinicians decide whether patient patients can be managed as outpatients or not

Rockall score used after endoscopy: provides a percentage risk of rebleeding and mortality

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71
Q

Which score provides a percentage risk of rebleeding and mortality in upper GI bleeds?

A

Rockall

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72
Q

Location of tenderness typically in UC?

A

Left lower quadrant

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73
Q

What is most common extra-intestinal feature in both CD and UC?

A

Arthritis

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74
Q

Type of resection in anal verge cancers?

A

Abdomino-perineal excision of rectum (no anastomosis)

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75
Q

Patients are at increased risk of which cancers following radiotherapy for prostate cancer?

A

bladder, colon, and rectal cancer

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76
Q

How is chronic urinary retention characterised?

A

by being painless and insidious.

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77
Q

Cause of high pressure urinary retention?

A

Typically due to bladder outflow obstruction e.g. in BPH

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78
Q

Features of high pressure urinary retention vs low?

A

High:
- impaired renal function
- bilateral hydronephrosis

Low:
- normal renal function
- no hydronephrosis

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79
Q

What commonly occurs after catheterisation for chronic urinary retention?

A

Decompression haematuria due to the rapid decrease in the pressure in the bladder (no further treatment required)

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80
Q

Management options for localised prostate cancer (T1/T2)?

A

Depends on patient choice and life expectancy:

1) conservative: active monitoring & watchful waiting (particularly in patients with significant comorbidities)

2) radical prostatectomy

3) radiotherapy: external beam and brachytherapy

81
Q

Give 4 causes of acute diarrhoea

A

1) gastroenteritis

2) diverticulitis

3) Abx therapy

4) constipation causing overflow

82
Q

How does diverticulitis classically present?

A

Left lower quadrant pain, diarrhoea and fever

83
Q

What type of abx is diarrhoea common with?

A

Broad spectrum (also C. diff infection)

84
Q

Typical history with constipation causing overflow?

A

A history of alternating diarrhoea and constipation may be given

May lead to faecal incontinence in the elderly

May have mass in left side of abdomen.

85
Q

LFTs with pancreatic cancer?

A

Typically cause obstructive pattern on LFTs e.g. elevated bilirubin

86
Q

What scoring system can be used in suspected upper GI bleeds to determine severity of bleed and whether or not they could be safely managed as an outpatient?

A

Glasgow-Blatchford

87
Q

When assessing the severity of liver cirrhosis, what is best indicator in showing functional capacity of liver?

A

Albumin or coagulation

88
Q

What classification is used to predict mortality in cirrhosis patients?

A

Child-Pugh classification

89
Q

What can liver enzymes indicate?

A

Where primary disorder is hepatitis or cholestatic in origin

90
Q

Is prothrombin time or albumin a better measure of acute liver failure? Why?

A

Prothrombin as has a shorter half life than albumin

91
Q

Histology in coeliac disease?

A
  • villous atrophy
  • raised intra-epithelial lymphocytes
  • crypt hyperplasia
92
Q

1st line management of mild-moderate flare of distal UC?

A

Topical (rectal) aminosalicylates

93
Q

What triad is seen in mesenteric ischaemia?

A

1) CVD
2) high lactate
3) soft but tender abdomen

94
Q

In a mild-moderate flare of UC extending past the left-sided colon, what should be added to rectal aminosalicylates?

A

Oral aminosalicylates

95
Q

What is carcinoid syndrome?

A

Features of diarrhoea, flushing, and palpitations.

This is caused by secretion of serotonin by cancer.

It is more common when the tumour has spread to the liver and releases hormones such as serotonin into the bloodstream.

96
Q

What weight loss over 3-6 months is diagnostic of malnutrition?

A

Unintentional weight loss >10% of body weight over 3-6 months

97
Q

In ascites 2ary to liver cirrhosis, what is the preferred diuretic?

A

Spironolactone (aldosterone antagonists) - combat sodium retention.

98
Q

In T2DM with abnormal LFTs, what condition should you consider?

A

Non alcoholic fatty liver disease

99
Q

What are the options for management of uninvestigated dyspepsia symptoms?

A

Either:

1) Prescribe a full dose PPI for 1 month

OR

2) Test for H. pylori infection if status is unknown: if positive then 1st line eradication

Whichever option is tried first and fails, try the second one next.

100
Q

What is the AST/ALT ratio in alcoholic hepatitis?

A

2:1

101
Q

Clinical features of alcohol hepatitis?

A

jaundice, anorexia, fever, tender hepatomegaly

may have RUQ pain/epigastric pain, hepatic encephalopathy, signs of malnutrition etc

102
Q

What is used to monitor treatment in haemochromatosis?

A

Ferritin & transferrin saturation

103
Q

What is the characteristic iron study profile in haemochromatosis?

A

Raised transferrin saturation & ferritin with low total iron binding capacity

104
Q

What is transferrin?

A

An iron transport protein in plasma which INCREASES in iron deficiency to maximise the utilisation of available iron.

105
Q

What does total iron binding capacity reflect?

A

Reflects the availability of iron-binding sites on transferrin.

Levels INCREASE in iron deficiency and DECREASE in iron overload.

106
Q

Most common cause of travellers diarrhoea?

A

enterotoxigenic Escherichia coli

107
Q

What is small bowel overgrowth syndrome (SBBOS)?

A

A disorder characterised by excessive amounts of bacteria in the small bowel resulting in GI symptoms.

108
Q

What are the 3 risk factors for SBBOS?

A

1) neonates with congenital gastrointestinal abnormalities

2) scleroderma

3) diabetes mellitus

109
Q

Features of SBBOS?

A

Many overlap with IBS:

1) chronic diarrhoea
2) bloating, flatulence
3) abdominal pain

110
Q

How is a diagnosis of SBBOS made?

A

hydrogen breath test

111
Q

Management of SBBOS?

A

1) correction of the underlying disorder

2) Abx: rifaximin is treatment of choice

112
Q

How long must patients consume gluten for before they are tested for coeliac disease?

A

6 weeks

113
Q

Risk factors for development of gallstones?

A
  • increasing age
  • FH
  • sudden weight loss e.g. after obesity surgery
  • loss of bile salts e.g. ileal resection, terminal ileitis.
  • diabetes
  • oral contraception
114
Q

How is Crohn’s a risk factor for gallstones?

A

Crohn’s disease can result in terminal ileitis, this is the section of the bowel where bile salts are reabsorbed.

When this area is inflamed and the bile salts are not absorbed and people are prone to development of gallstones.

115
Q

what is zollinger ellison syndrome?

A

Zollinger-Ellison syndrome is a condition characterised by excessive levels of gastrin secondary to a gastrin-secreting tumour.

116
Q

Where are the majority of gastrin secreting tumours found in zollinger ellison syndrome?

A

First part of the duodenum (second most common location is the pancreas)

117
Q

Features of zollinger ellison syndrome?

A

1) multiple gastroduodenal ulcers
2) diarrhoea
3) malabsorption

118
Q

around 1/3 of patients with gastrinomas have what condition?

A

MEN type I syndrome

119
Q

Histology features in UC vs Crohn’s?

A

UC:
- no inflammation beyond submucosa
- crypt abscesses
- depletion of goblet cells

Crohn’s:
- inflammation in all layers from mucosa to serosa
- increased goblet cells
- granulomas

120
Q

Whatare the causes of Dupuytren’s contracture?

A

1) manual labour
2) phenytoin treatment
3) alcoholic liver disease
4) diabetes mellitus
5) trauma to the hand

121
Q

What is hereditary haemorrhagic telangiectasia (HHT)?

A

An autosomal dominant condition characterised by multiple telangiectasia over the skin and mucous membranes.

122
Q

What are the 4 main diagnostic criteria for HHS?

A

1) epistaxis : spontaneous, recurrent nosebleeds

2) telangiectases: multiple at characteristic sites (lips, oral cavity, fingers, nose)

3) visceral lesions: for example gastrointestinal telangiectasia (with or without bleeding), pulmonary arteriovenous malformations (AVM), hepatic AVM, cerebral AVM, spinal AVM\

4) family history: a first-degree relative with HHT

123
Q

What is 1st line in maintaining remission in UC patients with proctitis and proctosigmoiditis?

A

Topical (rectal) aminosalicylate +/- oral aminosalicylate

124
Q

What is the classical barium enema finding in chronic UC?

A

Lead pipe appearance of colon: complete loss of haustral markings in the diseased segment, appearing smooth-walled and cylindrical.

125
Q

What is 1st line in maintaining remission in UC patients with left-sided and extensive ulcerative colitis?

A

low maintenance dose of an oral aminosalicylate

126
Q

Following a severe relapse in UC, or >/= 2 exacerbations in the past year, what is the management?

A

oral azathioprine or oral mercaptopurine to maintain remission.

127
Q

What is the most common cause of chronic diarrhoea in infants?

A

cow’s milk intolerance

128
Q

What is toddler diarrhoea?

A

Chronic nonspecific diarrhoea in infants –> stools often contain undigested food.

129
Q

What is used 1st line to maintain remission in patients with Crohn’s?

A

Azathioprine or mercaptopurine

130
Q

What is pseudomembranous colitis?

A

Inflammation of the colon associated with an overgrowth of the bacterium Clostridioides difficile.

Often follows Abx course.

131
Q

How does C. diff infection present on sigmoidoscopy?

A

yellow plaques on the intraluminal wall of the colon.

132
Q

What is giardiasis?

A

a protozoan parasite transmitted via the faecal-oral route

133
Q

1st line treatment of giardiasis?

A

metronidazole

134
Q

Features of giardiasis?

A
  • history of foreign travel
  • often asymptomatic
  • non-bloody diarrhoea: steatorrhoea
  • bloating, abdominal pain
  • lethargy
  • flatulence
  • weight loss
  • malabsorption and lactose intolerance can occur
135
Q

If a mild-moderate flare of ulcerative colitis does not respond to topical or oral aminosalicylates, what should be added?

A

oral corticosteroids

136
Q

What is often a presenting feature of CF in the neonatal period (i.e. first manifestation)?

A

meconium ileus

137
Q

What are the 4 typical presenting features of cystic fibrosis (CF)?

A

1) neonatal period (around 20%): meconium ileus, less commonly prolonged jaundice

2) recurrent chest infections (40%)

3) malabsorption (30%): steatorrhoea, failure to thrive

4) other features (10%): liver disease

138
Q

Ohther features of CF?

A
  • short stature
  • diabetes mellitus
  • delayed puberty
  • rectal prolapse (due to bulky stools)
  • nasal polyps
  • male infertility, female subfertility
139
Q

What is the most common symptom of Crohn’s disease in children?

A

Abdo pain

140
Q

Who should serum Ca125 be performed in?

A

Aged >50 and has any of the following symptoms on a regular basis:

1) abdo distension or bloating

2) early satiety or loss of appetite

3) pelvic or abdo pain

4) increased urinary urgency and/or frequency

141
Q

What are 3 megaloblastic causes of macrocytic anaemia?

A

1) vit D deficiency

2) folate deficiency

3) 2ary to methotrexate (causing folate deficiency)

142
Q

What drug is one of the most notable causes of hypomagnesaemia?

A

PPIs

143
Q

What IBD does increased goblet cells indicate?

A

Crohn’s

144
Q

What is the Mantoux test?

A

one method of determining whether a person is infected with Mycobacterium tuberculosis

145
Q

What are some causes of a false negative Mantoux test?

A
  • immunosuppression (miliary TB, AIDS, steroid therapy) e.g. well controlled IBD with long term predisolone
  • sarcoidosis
  • lymphoma
  • extremes of age
  • fever
  • hypoalbuminaemia, anaemia
146
Q

In patients with severe colitis, what investigation should be avoided?

A

Colonoscopy - due to risk of perforation

147
Q

What investigation is recommended over a colonoscopy in severe colitis?

A

Flexible sigmoidoscopy

148
Q

What is Mittelschmerz?

A

Mid cycle pain that typically occurs because a small amount of fluid is released at the time of ovulation. It will usually resolve over 24-48 hours.

149
Q

Which IBD is associated with abdo mass palpable in RIF?

A

Crohn’s

150
Q

What is the investigation of choice for suspected perianal fistulae in patients with Crohn’s?

A

MRI pelvis

151
Q

What should be a top differential for: diarrhoea + fatigue + osteomalacia?

A

Coeliac disease

152
Q

How does coeliac lead to osteomalacia?

A

impaired vitamin D absorption secondary to villous atrophy

153
Q

Transient lactose intolerance is a common complication of what?

A

viral gastroenteritis

154
Q

how can coeliac disease affect a) iron, b) folate, c) vit D deficiency?

A

Coeliac disease is associated with iron, folate and vitamin B12 deficiency

155
Q

How is ALP & calcium affected in osteomalacia?

A

ALP –> raised

Calcium –> low

156
Q

What is Abx of choice in the management of Crohn’s patients who develop an perianal fistula?

A

Oral metronidazole –> must have anaerobic organism cover for perianal fistulas

157
Q

What cancer can Helicobacter pylori infection lead to?

A

gastric lymphoma (MALT): typically arise in the antrum of the stomach and can present with systemic features such as fevers and night sweats.

158
Q

How can urea levels help determine between upper and lower GI bleed?

A

High urea levels can indicate an upper GI bleed versus lower GI bleed

159
Q

What is the main cause of painless massive GI bleeding requiring a transfusion in children between the ages of 1 and 2 years?

A

Meckels diverticulum

160
Q

Presentation of chronic pancreatitis?

A

1) abdo pain following meals

2) steatorrhoea

3) diabetes

161
Q

What cancer does coeliac disease increase the risk of?

A

enteropathy-associated T cell lymphoma

162
Q

If a patient with ulcerative colitis has had a severe relapse or >=2 exacerbations in the past year, what should they be given?

A

oral azathioprine or oral mercaptopurine

163
Q

What IBD are crypt abscesses more common in?

A

UC

164
Q

What site is most commonly affected in UC?

A

Rectum

165
Q

How often should patients with coeliac disease be given the pneumococcal vaccine?

A

every 5 years

166
Q

How do thrombosed haemorrhoids present?

A

1) significant pain & tender lump
2) examination reveals a purplish, oedematous, tender subcutaneous perianal mass

167
Q

Management of thrombosed haemorrhoids?

A

1) if patient presents within 72 hours then referral –> consider for excision.

2) otherwise patients can usually be managed with stool softeners, ice packs and analgesia.

Symptoms usually settle within 10 days

168
Q

Give 5 main causes of rectal bleeding?

A

1) fissure in ano

2) haemorrhoids

3) Crohn’s

4) UC

5) rectal cancer

169
Q

Describe bleeding in fissure in ano vs haemorrhoids

A

Both present with bright red rectal bleeding.

Fissure:
- Painful bleeding that occurs post defecation in small volumes.
- Usually preceded by constipation

Haemorrhoids:
- Post defecation bleeding noted both on toilet paper and drips into pan.
- May be alteration of bowel habit and history of straining.
- No blood mixed with stool or local pain.

170
Q

Why is Crohn’s disease a risk factor for gallstones?

A

Because it affects the terminal ileum which is involved in the metabolism of bile salts.

Excessive bile salts escape into the colon and are reabsorbed and return to the liver, resulting in excessive secretion of bile pigments and the production of black stones.

171
Q

Is there a FH risk with IBD?

A

There is a seven-fold increased risk of developing IBD for patients with a first-degree relative with IBD.

172
Q

1st line management step in toxic megacolon?

A

Insertion of NG tube for decompression of the bowel.

173
Q

How can coeliac disease affect platelets?

A

Often causes thrombocytosis

174
Q

Why is Crohn’s a risk factor for a peri-anal fistula?

A

In Crohn’s disease the bowel wall is perforated due to chronic inflammation allowing a passage to develop between the bowel and skin

175
Q

Describe dermatitis herpetiformis

A

a dermatological manifestation of coeliac disease, characterised by pruritic papulovesicular lesions over the extensor surfaces of the arms, legs, buttocks, and trunk

176
Q

What cancer can cause acanthosis nigricans?

A

Gastric adenocarcinoma

177
Q

What are some causes of acanthosis nigricans?

A

1) T2DM
2) GI cancer (most commonly gastric)
3) obesity
4) polycystic ovarian syndrome
5) Cushing’s disease
6) hypothyroidism
7) familial
8) Prader-Willi syndrome
9) drugs: COCP, nicotinic acid

178
Q

What condition is H. pylori infection MOST commonly associated with?

A

Duodenal ucleration

179
Q

Management of gastro-oesophageal reflux in infants?

A

1) position changes during feeds (30 degree head up)

2) ensure infant is not being overfed (as per their weight) - trial of smaller more frequent feeds

3) trial of thickened formula

4) trial of alginate therapy e.g. gaviscon (alginates should NOT be used at same time as thickening agents)

5) consider PPI ONLY if 1 or more of the following apply:
- unexplained feeding difficulties (for example, refusing feeds, gagging or choking)
- distressed behaviour
- faltering growth

180
Q

What age does intussuception usually affect?

A

Infants 6-18 months (boys 2x more than girls)

181
Q

Features of intussusception?

A
  • intermittent, severe, crampy, progressive abdominal pain
  • inconsolable crying
  • during paroxysm the infant will characteristically draw their knees up and turn pale
  • vomiting
  • bloodstained stool - ‘red-currant jelly’ - is a late sign
  • sausage-shaped mass in the right upper quadrant
182
Q

Investigation of choice in intussusception in adults?

A

US - may show a target like mass

183
Q

Give 4 absolute contraindications to laparoscopic surgery

A

1) haemodynamic instability/shock

2) raised intracranial pressure

3) acute intestinal obstruction with dilated bowel loops (e.g. > 4 cm)

4) uncorrected coagulopathy

184
Q

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

A

Adenocarcinoma

185
Q

Who is oesophageal adenocarcinoma more likely to develop in?

A

GORD or Barrett’s.

186
Q

Where are the majority of oesophageal adenocarcinomas located?

A

Near the gastroesophageal junction

187
Q

Where are the majority of squamous cell oesophageal cancers located?

A

Upper two-thirds of the oesophagus

188
Q

What is the most common type of oesophageal cancer in developing world?

A

Squamous cell carcinoma

189
Q

Risk factors for oesophageal adenocarcinoma vs squamous cell?

A

Adenocarcinoma:
- GORD
- Barrett’s oesophagus
- Smoking
- Obesity

Squamous cell cancer:
- Smoking
- Alcohol
- Achalasia
- Plummer-Vinson syndrome
- Diets rich in nitrosamines

190
Q

When should PPIs be trialled in infants with GORD?

A

In those who do not respond to alginates/thickened feeds and who have
1. feeding difficulties,
2. distressed behaviour or
3. faltering growth

191
Q

Fistula formation is a possible complication of diverticular disease.

What happens?

A

a diverticular abscess ruptures into an adjacent organ

192
Q

What is the most common fistula to form in diverticular disease?

A

This most frequently happens between the sigmoid colon and the urinary bladder (i.e. colovesical), causing symptoms such as pneumaturia, faecaluria or recurrent urinary tract infections.

193
Q

Symptoms of a colovesical fistula?

A
  • pneumaturia
  • faecaluria
  • recent UTIs
194
Q

What condition does right sided tenderness during a DRE indicate?

A

acute appendicitis

195
Q

How long before an upper GI endoscopy should PPIs be stopped?

A

2 weeks

196
Q

Where does biliary colic pain radiate into?

A

interscapular region

197
Q

Patients with diverticulitis flares can be managed with oral antibiotics at home.

What is the 2nd line if they do not improve within 72 hours?

A

Admit for IV ceftriaxone + metronidazole

198
Q

What is the investigation of choice for stable children with suspected Meckel’s diverticulum?

A

A technetium scan

Yr 4 - CCC (54 decks)

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