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GI Alimentary Year 2 Medicine > Diseases > Flashcards

Diseases Flashcards

1
Q
A
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2
Q

What are the signs of spontaneous bacterial peritonitis?

A

Renal impairment
Signs of sepsis
Tachycardia
Temperature

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3
Q

What is spontaneous bacterial peritonitis?

A

infection of ascitic fluid

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4
Q

What investigations are done for spontaneous bacterial peritonitis?

A

Ascitic tap

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5
Q

What is the neutrophil count in spontaneous bacterial peritonitis?

A

>0.25x109/L

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6
Q

What sex metabolises alcohol slower?

A

Women

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7
Q

What are the risk factors for fatty liver disease?

A

Obesity
Diabetes
Hypercholesterolaemia
Alcohol

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8
Q

What are the symptoms of Non alcoholic steatohepatitis (NASH)?

A

Asymptomatic

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9
Q

What is the treatment for NASH?

A

Weight loss
Exercise

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10
Q

What is the protein count is spontaneous bacterial peritonitis?

A

<25g/l

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11
Q

What are the treatment options for spontaneous bacterial peritonitis?

A

IV antibiotics
Ascitic fluid drainage
IV albumin infusions

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12
Q

What is seen on blood tests for NASH?

A

Raised alanine amino transferase

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13
Q

What are the signs of alcoholic hepatitis?

A

Jaundice
Encephalopathy
Decompensated hepatic function

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14
Q

What is common in alcoholic hepatitis?

A

Infection

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15
Q

What is steatohepatitis?

A

fatty liver with inflammation

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16
Q

What is steatosis?

A

fatty liver

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17
Q

What is seen on the blood test for alcoholic hepatitis?

A

Raised bilirubin
Raised GGT and AlkP

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18
Q

What are the causes of hepatic encephalopathy?

A

Infection
Drugs
Constipation
GI bleed
Electrolyte disturbances

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19
Q

What are the supportive treatments for hepatic encephalopathy?

A

ITU
Airway support
Nasogastric tube

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20
Q

What is the mortality of alcoholic hepatitis?

A

40%

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21
Q

What are the medical treatments for hepatic encephalopathy?

A

Bowel clear out
Lactulose
Enemas
Antibiotics

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22
Q

What is seen in lab tests due in alcoholic liver disease?

A

AAT/ALT ratio >2
Raised Gamma GT
Macrocytosis
Low platelets

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23
Q

What is hepatic encephalopathy?

A

impaired brain function associated with hepatic insufficiency

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24
Q

What are the treatment options for alcoholic hepatitis?

A

Treat infection
Treat encephalopathy
Treat alcohol withdrawal
Protect against GI bleed

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25
Q

When would you give steroids for alcoholic hepatitis?

A

If grading severe
Glasgow alcoholic hepatitis score >9

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26
Q

Why would steroids only be given in severe alcoholic hepatitis?

A

Due to increased risk of GI bleed and infection

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27
Q

What percentage of those with alcoholic hepatitis are malnourished?

A

100%

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28
Q

What are the symptoms of spontaneous bacterial peritonitis?

A

Abdominal pain
Fevers
Rigours

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29
Q

What vitamin are those with alcoholic hepatitis deficient in?

A

Thiamine

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30
Q

What are the nutritional requirements of those with alcoholic hepatitis?

A

Frequent feeds
High energy requirement

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31
Q

What is bilirubin general by?

A

Senescent RBC’s in spleen

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32
Q

What are unconjugated bilirubin bound to?

A

Albumin

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33
Q

What are the signs of post-hepatic jaundice?

A

Palpable gall bladder

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34
Q

What is bilirubin?

A

Byproduct of haeme metabolism

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35
Q

What are the causes of hepatic jaundice?

A

Defective uptake of bilirubin
Defective conjugation
Defective excretion

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36
Q

What is alkaline phosphatase?

A

Enzyme present in bile duct

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37
Q

What is the most important investigation for jaundice?

A

Ultrasound of abdomen

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38
Q

What can liver screen determine?

A

Hep B and C serology
Autoantibody profile
Ferritin

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39
Q

What solubisises bilirubin to conjugate it?

A

Liver

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40
Q

What are the causes of post-hepatic jaundice?

A

Defective transport of bilirubin by the biliary ducts

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41
Q

Where is alkaline phosphatase found?

A

Bone
Placenta
Intestines
Liver

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42
Q

When is alkaline phosphatase elevated?

A

With obstruction of liver infiltration

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43
Q

Which CP can only image ducts?

A

ERCP

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44
Q

What is Gamma GT?

A

Non specific liver enzyme

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45
Q

What are the detoxification functions of the liver?

A

Urea production from ammonia
Detoxification of drugs
Bilirubin metabolism
Breakdown of insulin and hormones

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46
Q

When is Gamma GT elevated?

A

With alcohol use

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47
Q

What drugs can raise levels of Gamma GT?

A

NSAIDS

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48
Q

What are the post hepatic causes of bilirubin elevation?

A

Obstructive

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49
Q

What are the signs of pre-hepatic jaundice?

A

Pallor
Splenomegaly

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50
Q

What are the pre hepatic causes of bilirubin elevation ?

A

Haemolysis

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51
Q

What does low levels of albumin suggest?

A

Chronic liver disease

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52
Q

What are the functions of the carbohydrates in the liver?

A

Gluconeogenesis
Glycogenolysis
Glycogenesis

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53
Q

What are the hepatic causes of bilirubin elevation?

A

Parenchymal damage

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54
Q

What are aminotransferases?

A

Enzymes present in hepatocytes?

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55
Q

What does the prothrombin time tell?

A

Degree of liver dysfunction

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56
Q

What are the hormones of the liver?

A

Angiotensinogen

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57
Q

Name the aminotransferases?

A

ALT
AST

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58
Q

What CP does not use radiation?

A

MRCP

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59
Q

What aminotransferase is more specific?

A

ALT

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60
Q

What is the prothrombin time used to calculate?

A

Stage of liver disease

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61
Q

What can therapeutic ERPC be used for?

A

Acute gallstone pancreatitis
Stenting of biliary tract obstructuin
Post-op biliary complications

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62
Q

What does creatinine determine?

A

Survival from liver disease

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63
Q

What does the AST/ ALT radio suggest?

A

Parenchymal involvement

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64
Q

What are the procedure related complications of ERCP?

A

Pancreatitis
Cholangitis
Sphincterotomy

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65
Q

What are the uses of PTC?

A

ERCP not possible due to duodenal obstruction
Hilar stenting

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66
Q

What are the functions of the lipids in the liver?

A

Cholesterol synthesis
Lipoprotein
TG synthesis

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67
Q

What results in low platelet count?

A

Cirrhosis

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68
Q

what are the functions of the proteins in the liver?

A

Albumin synthesis

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69
Q

What are the symptoms of liver failure?

A

Jaundice
Ascites
Variceal bleeding
Hepatic encephalopathy

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70
Q

What are the disadvantages of PTC?

A

More invasive

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71
Q

What are the immune functions of the liver?

A

Combating infections
Clearing the blood of particles and infections, including bacteria
Neutralising and destroying all drugs and toxins

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72
Q

When is jaundice detectable?

A

When total plasma bilirubin >34umol/l

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73
Q

What does the liver store?

A

Glycogen
Vitamins
Copper
Iron

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74
Q

What is an endoscopic ultrasound used for?

A

Characterising pancreatic masses
Staging of tumours

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75
Q

What is the differential diagnosis for jaundice?

A

Carotenemia

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76
Q

What are the signs of hepatic jaundice?

A

Stigmata of CLD
Ascites (fluid in abdo)
Asterixis (flap)

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77
Q

What vitamins does the liver store?

A

A, D, E, K, B12

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78
Q

What are the causes of pre-hepatic jaundice?

A

Increased quality of bilirubin
Impaired transport

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79
Q

What can choledocholithiasis lead to?

A

Acute pancreatitis
Ascending cholangitis

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80
Q

What are the blood tests done to investigate gallstone?

A

LFT’s
Amylase
Lipase
WCC

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81
Q

What are the palliative options cholangiocarcinoma?

A

Surgical bypass
Stenting
Palliative radiotherapy
Chemotherapy
PDT

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82
Q

What are the imaging investigations done for gallstones?

A

CT scan
USS
EUS
HIDA

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83
Q

What is the gold standard of operative treatments of gallstones?

A

Laparoscopic cholecystectomy +/- OTC

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84
Q

What are the functions of the gallbladder?

A

Bile reservoir
Concentrates bile
Secrete CCK after meal

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85
Q

What are the treatments of CBD stones?

A

Lap/ open exploration
ERCP
Transhparic stone retrieval

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86
Q

Name congenital benign biliary tract diseases?

A

Biliary atresia
Cholecdochal cysts

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87
Q

Name benign biliary structure biliary tract disease?

A

Iatrogenic
Gallstones related
Inflammatory

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88
Q

What are the imaging investigations done for cholangiocarcinoma?

A

USS
EUS
CT
MRA
MRCP

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89
Q

What is cholangiocarcinoma?

A

bile duct cancer

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90
Q

How common is gallbladder cancer?

A

Rare
2-5% of GI cancers

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91
Q

What are the non operative treatment of gallstones?

A

Dissolution
Lithotripsy

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92
Q

Where is most cholangiocarcinoma found?

A

Extrahepatic hilar

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93
Q

Describe the prognosis of gallbladder cancer?

A

Poor except if detected early

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94
Q

What are does cholangiocarcinoma peak?

A

80 years

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95
Q

What are the treamtent options for ampullary tumours?

A

Endoscopic excision
Trans-duodenal excision
Pancreatico-duodenectomy

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96
Q

What are the risk factors for cholangiocarcinoma?

A

PSC
Congenital cystic disease
Biliary enteric drainage
Thorotrast

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97
Q

What is the treamtent for intrahepatic cholangicarcinoma?

A

Surgery

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98
Q

What is the composition of gallstones?

A

Cholesterol
Pigment

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99
Q

Name the types of intrahepatic cholangiocarcinomas?

A

Mass forming
Peri-ductal
Intra-ductal

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100
Q

What are the symptoms of cholangiocarcinoma?

A

Obstructive jaundice
Itching

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101
Q

What are the risk factors for gallstones?

A

Age
Gender
Parity
Cholesterol
Pigment

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102
Q

What are the symptoms of gallstones?

A

Dyspeptic symtpoms
Jaundice
Perforation
Empyema

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103
Q

What is choledocholithiasis?

A

gallstones in the common bile duct

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104
Q

What are the symptoms of obstructive jaundice due to choledocho-litiasis?

A

Pain
Jaundice
Dark urine
Pale stool
Pruritus
Steatorrhoea

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105
Q

What is IBD-U?

A

Unclassified
Symptoms of both Crohn’s and UC

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106
Q

What do genes that cause IBD affect?

A

Epithelial barrier
Immune responses
Bacterial handling

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107
Q

What causes genetic susceptibility to IBD?

A

Single nucleotide polymorphism

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108
Q

What is the change of an offspring developing IBD if the parent has it?

A

10% chance

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109
Q

Give examples of genes that can cause IBD?

A

NOD2
XBP1

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110
Q

What are the symptoms of UC?

A

Bloody diarrhoea
Abdominal pain
Weight loss
Fatigue

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111
Q

What is present in microbial communities in IBD?

A

Dysbiosis

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112
Q

Where does continuous inflammation in UC occur?

A

Only colon

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113
Q

Define inflammatory bowel disease

A

Chronic relapsing, remitting inflammation of GI tract

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114
Q

What percentage of patients will be a colectomy within ten years of diagnosis of UC?

A

20-30%

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115
Q

What is proctitis?

A

inflammation of the rectum

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116
Q

What age does IBD commonly present?

A

Teens and twenties

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117
Q

What are the symptoms of proctitis?

A

Increased Frequency
Increased urgency
Incontinence
Tenesmus

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118
Q

What is the treatment for proctitis?

A

Topical therapy

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119
Q

What is found in the stool in proctitis?

A

Small volume mucus and blood

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120
Q

How many people in the UK have IBD?

A

620,000

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121
Q

What is the risk of emergency colectomy in acute severe colitis?

A

20-30%

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122
Q

name the types of inflammatory bowel disease

A

Chohn’s
Ulcerative colitis

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123
Q

When is UC classed as mild?

A

<4 stools a day +/- blood
No signs of toxicity

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124
Q

When is UC classed as moderate?

A

4-6 stools a day
Occasional blood
CRP > 30mg/l

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125
Q

What would bloods show in UC?

A
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126
Q

What are treatments options for Hepatitis B?

A

Pegylated interferon
Oral antiviral drugs

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127
Q

What antibodies is present in primary biliary cholagnits?

A

Anti-mitochondrial antibody

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128
Q

What are the organ therapies available for hepatitis B?

A

Lamivudine
Adefovir
Tenofovir
Entercavir
Teldivudine

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129
Q

What sex does primary sclerosing cholangitis affect more?

A

Men

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130
Q

What are the biochemical tests done for diagnosis fo NAFLD?

A

AST/ ALT radio

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131
Q

What are the imaging tests done for the diagnosis of NAFLD?

A

MR
CT
Ultrasound

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132
Q

What are the pharmacological treatments of NAFLD?

A

Insulin sensitisers
GLP-1
Farnesoid X nuclear receptors ligand
Vit E

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133
Q

Give examples of contraindications for liver transplant?

A

Active substance of alcohol abuse
Malignancy
Anatomical barriers

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134
Q

When would you list for transplant in acetaminophen-induced ALF?

A

Arterial ph <7.3
Arterial lactate >3

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135
Q

What hepatitis viruses are enteric?

A

A and E

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136
Q

What percentage of those with Hep C present with jaundice?

A

10%

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137
Q

When would you list for transplant in non acetaminophen induced ALF?

A

INR > 6.5 and encephalopathy present

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138
Q

What scores are used in order to determine cirrhosis prioritisation for transplant?

A

Child’s Pugh scoring A, B and C
MELD
UKELD

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139
Q

What is the treatment for Hep C?

A

Direct acting antivirals (DAA)

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140
Q

What are the anti-rejection drugs given following a liver transplant?

A

Steroids
Azathioprine
Tacrolimus/ cyclosporine

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141
Q

What hepatitis viruses are parenteral?

A

B, C and D

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142
Q

What does HBcAg indicate?

A

Active replication
Not detected in blood

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143
Q

What is the transmission of hepatitis A?

A

fecal-oral
Sexual
Blood

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144
Q

What are the difficulties in treating hepatitis D?

A

Very resistant to treatment

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145
Q

Name the drugs used to treat hepatitis C?

A

Ledipasvir
ABT-267

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146
Q

What is the most common cause of acute hepatitis in NHS Grampian?

A

Hepatitis E

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147
Q

what age is hepatitis A most common?

A

5-14

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148
Q

What is the treatments for primary sclerosing cholangitis?

A

Liver transplant
Biliary stents

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149
Q

where is Hepatitis E mostly found?

A

Tropical countries

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150
Q

What does Anti-HBs (hep B surface antibody) indicate?

A

Recovery from infection or immunization

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151
Q

What conditions would a liver transplant be considered?

A

Acute liver failure
Hepatocellular carcinoma
Chronic liver disease
Genetic diseases

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152
Q

What is acute hepatitis A diagnosed by?

A

IgM antibodies

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153
Q

What are the surgical treatments for NAFLD?

A

Weight reduction surgery

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154
Q

What is hepatitis F?

A

Variant of hepatitis B

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155
Q

What immunoglobulin in increased in autoimmune hepatitis?

A

IgG

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156
Q

who do we immunize for hep A?

A

Travellers
Patients with chronis liver disease
Haemophiliacs
Occupational exposure
Men who have sex with men

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157
Q

What type of virus is hepatitis D?

A

Small RNA virus

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158
Q

What does the NAFLD term encompass?

A

Simple steatosis
Non-alcoholic steatohepatitis
Fibrosis and cirrhosis

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159
Q

What sex is autoimmune hepatitis most predominant in?

A

Females

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160
Q

What does IgM anti-HBc indicate?

A

acute infection

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161
Q

What antibodies are present in autoimmune hepatitis?

A

ANA
SMA
LKM1
SLA

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162
Q

What does IgG anti-HBc indicate?

A

Chronic infection/ exposure

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163
Q

What is found in the inner protein core of Hepatitis B?

A

HBV DNA
DNA polymerase

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164
Q

What investigation is used to diagnose autoimmune hepatitis?

A

Liver biopsy

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165
Q

What is the treatment for autoimmune hepatitis?

A

Azathioprine

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166
Q

What immunoglobin is elevated in primary biliary cholangitis?

A

IgM

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167
Q

What does Anti-HBe indicate?

A

Inactive virus

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168
Q

What is the inner core of hepatitis B made of?

A

HBeAg

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169
Q

What duct is involved in primary biliary cholangitis?

A

Intrahepatic bile duct

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170
Q

What does HBsAg indicate?

A

Active HBV infection

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171
Q

What are the symptoms of primary biliary cholangitis?

A

Pruritus
Fatigue

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172
Q

What does HBeAg indicate?

A

Active replication

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173
Q

What antibodies is found in primary sclerosing cholangitis?

A

PANCA

174
Q

What is the test of choice to diagnose primary sclerosing cholangitis?

A

MRCP

175
Q

What genes give an increased risk of NAFLD?

A

PNPLA3

176
Q

What type of condition is hereditary pancreatitis?

A

Autosomal dominant

177
Q

What are the clinical features of chronic pancreatitis?

A

Abdominal pain
Exocrine insufficiency
Endocrine insufficiency

178
Q

What are the investigations done to diagnose chronic pancreatitis?

A

CT
MRI
EUS

179
Q

What are medical managements for chronic pancreatitis?

A

Non opioid analgesics
Antiodixens

180
Q

What are the imaging investigations done for pancreatic cysts?

A

CT
MRI
EUS

181
Q

Define chronic pancreatitis

A

Continuing inflammatory disease characterised by irreversible glandular destruction and typically causing pain or loss of function

182
Q

What are the non pharmacological treatments of chronic pancreatitis?

A

Well balanced diet
Cessation of alcohol and tobacco

183
Q

What are the high risk factors of pancreatic cysts?

A

Jaundice
>10mm

184
Q

What does EUS determine in pancreatic cysts?

A

Mucinous vs non- mucinous
Benign vs malignant

185
Q

What is the incidence of chronic pancreatitis?

A

5-8 cases per 100,000

186
Q

What are the causes of chronic pancreatitis?

A

Alcohol
CF
Congenital anatomical abnormalities
Hypercalcaemia

187
Q

What are the DNA bio markers foe pancreatic cysts?

A

GNAS
KRAS

188
Q

What amylase level would be found in a lab test for pancreatic cysts?

A

<250

189
Q

What are the symptoms of carcinoma of the pancreas?

A

Upper abdominal pain
Jaundice
Weight loss
Anorexia

190
Q

What happens to the fat nodules in carcinoma in the pancreas?

A

Tender subcutaneous fat nodules due to metastatic

191
Q

Give examples of congenital anatomical abnormalities that may cause chronic pancreatitis

A

Annular pancreas
Pancreas divisum

192
Q

Where would the cancer of the pancreas most likely be if a patient presented with abdominal pain?

A

Body and tail

193
Q

What are the signs of carcinoma of the pancreas?

A

Thrombophlebitis migrants
Ascites
Portal hypertension

194
Q

What is used for block is EUS Guided coeliac plexus block and neurolysis?

A

0.25% Bupivacaine
Triamcinolone

195
Q

What is used for neurolysis in EUS Guided coeliac plexus block and neurolysis?

A

0.25% Bupivacaine
Absolute alcohol

196
Q

What are the BD-IPMN indications for surgery of mucinous cystic neoplasia of the pancreas in the elderly?

A

>3cm without high risk stigmata

197
Q

What are the BD-IPMN indications for surgery of mucinous cystic neoplasia of the pancreas in younger patients?

A

>2cm

198
Q

What are the symptoms of head of pancreas cancer?

A

Obstructive jaundice
Diabetes
Abdominal pain
Anorexia
Weight loss

199
Q

Name the methods of reception of mucinous cystic neoplasia of the pancreas

A

Pancreatectomy
Focal
Laparoscopic
Robotic
Total

200
Q

What are the tumour bio markers for head of pancreas cancer?

A

CA19-9

201
Q

When is CT scanning useful in acute pancreatitis?

A

In severe disease
To acccess for complications

202
Q

What are the general investigations done for head of pancreas cancer?

A

Blood tests
CXR

203
Q

When is CT scanning done for acute pancreatitis?

A

Days 4-10 to identify necrosis

204
Q

What is the nutritional management of those with acute pancreatitis?

A

Nasogastric feeding

205
Q

what are the imaging investigations done for head of pancreas cancer?

A

USS
CT
MRCP

206
Q

How can acute pancreatitis be prevented in future?

A

Management of gallstones
Investigations of non gallstone pancreatitis
Alcohol abstinence

207
Q

Name the types of surgery’s used for head of pancreas cancer?

A

Kausch- Whipple’s
PPPD

208
Q

What is the management of infected necrosis in acute pancreatitis?

A

Laporotomy

209
Q

What is the treatment for obstructive jaundice in palliative head of pancreas cancer?

A

Palliative bypass
ERCP
PTC stent

210
Q

What is the treatment for duodenal obstructive in the palliative head of pancreas cancer?

A

Palliative bypass
Duodenal stent

211
Q

What are the late complications of acute pancreatitis?

A

Haemorrhage
Portal hypertension

212
Q

What are the causes of chronic pancreatitis?

A

Obstruction
Autoimmune
Toxin
Idiopathic
Genetic
Environmental
Recurrent injuries

213
Q

What dominates genes if present give an increased risk of Ch pancreatitis?

A

Condon 29 and 122

214
Q

What recessive genes if present give and increased risk of Ch pancreatitis?

A

CFTR
SPINK1
Codon 1

215
Q

Define acute pancreatitis

A

Acute inflammatory process of the pancreas

216
Q

What are the complications of surgery for chronic pancreatitis?

A

Pancreatic duct stenosis
Cyst
Biliary track obstructive
Splenic vein thrombosis

217
Q

What age is head of pancreas cancer most common?

A

60-80 years

218
Q

What are the intervential produces done for chronic pancreatitis?

A

Endoscopic PD sphincetotomy dilation and lithotripsy
Coeliac plexus block

219
Q

What is severe acute pancreatitis associated with?

A

Organ failure
Local complication

220
Q

What are the local complications of acute pancreatitis?

A

Acute fluid collections
Pseudo cyst
Pancreatic abscess
Pancreatic necrosis

221
Q

What are the main causes of acute pancreatitis?

A

Gallstones
Alcohol

222
Q

How does alcohol cause acute pancreatitis?

A

Direct injury
Increased sensitivity to simulation
Oxidation pro cuts
Non oxidative metabolism

223
Q

How does gallstones cause acute pancreatitis?

A

Raises pancreatic ductal pressure

224
Q

What are the symptoms of acute pancreatitis?

A

Abdominal pain
Nausea
Vomiting
Collapse

225
Q

What are the risk factors for head of pancreas cancer?

A

Smoking
Chronic pancreatitis
Diabetes
Hereditary pancreatitis

226
Q

What are the types of resection surgery for chronic pancreatitis?

A

DPPHR
PPPD
Whipples pancreatic-duodenectomy

227
Q

What are the signs of acute pancreatitis?

A

Pyrexia
Dehydration
Abdominal tenderness
Circulatory failure

228
Q

What is the initial management for acute pancreatitis?

A

Analgesia
IV fluids

229
Q

Periampullary cancer is a feature of which genetic marker?

A

FAP

230
Q

What are the MD-IPMN high risk stigmata features of mucinous cystic neoplasia of the pancreas?

A

MPD >10mm
Enchanted solid component

231
Q

What are the MCN high risk stigmata features of mucinous cystic neoplasia of the pancreas?

A

>1cm with enchhanced solid component
MPD >1C,

232
Q

What are the imaging investigations done for acute pancreatitis?

A

CXR
USS
CT

233
Q

What markers indicate severe acute pancreatitis?

A

CRP > 200
IL 6
TAP

234
Q

What faecal calprotectin is classed as normal?

A

0-50ug/g

235
Q

What faecal calprotectin is classed as elevated?

A

>200

236
Q

What are the investigations done for UC?

A

Bloods
Stool culture
Faecal calprotectin
Colonoscopy

237
Q

What is faecal calprotectin?

A

Marker for inflammation in GI tract

238
Q

What drugs are given in acute severe colitis?

A

Low weight molecule heparin
IV glucocorticoids
IV hydration

239
Q

What investigations of done for acute severe colitis?

A

Blood tests
Stool chart
4 stool cultures for C. Diff

240
Q

What imaging investigation is done for acute severe colitis?

A

Abdo XR

241
Q

What can precipitate toxic mega colon?

A

Low potassium or magnesium

242
Q

What are the symptoms of Crohn’s disease?

A

Diarrhoea
Abdominal pain
Weight loss
Malabsorption

243
Q

What may malabsorption due to Crohn’s disease lead to?

A

Anaemia
Vitamin deficiency

244
Q

What are the investigations done for Crohn’s disease?

A

Bloods
Stool culture
Faecal calprotectin
Colonoscopy
MRI small bowel study
Capsule endoscopy

245
Q

What are the complications of Crohn’s disease due to?

A

Transmural inflammation

246
Q

Which type of IBD shows granulomas in its histology

A

Crohn’s disease

247
Q

What cells are depleted in UC?

A

Goblet cells

248
Q

Which IBD has more crypt abscesses?

A

UC

249
Q

What are the symptoms of perianal Crohn’s disease?

A

Perianal pain
Pus secretion
Unable to sit down

250
Q

what are the investigations done for perianal Crohn’s disease?

A

MRI pelvis
Examination under anaesthetic

251
Q

What are the medical treatment(s) of perianal Crohn’s disease?

A

Antibiotics and biblical therapy
Surgery

252
Q

v

What are some extra-intestinal manifestations of IBD?

A

Mouth ulcers
Skin rashes
Eye problems
Musculoskeletal problems
Primary sclerosing cholangitis

253
Q

What are other causes of chronic diarrhoea?

A

Malabsorption
IBS
Overflow diarrhoea

254
Q

What are the long term complications of colitis?

A

Colonic carcinoma

255
Q

Give examples of aminosalicylates (5-ASAs)

A

Mesalazine
Ethylcelluluse microgranules

256
Q

How does 5-ASAs work?

A

Blocking prostaglandin and Leukotrienes
Release mechanisms lead to colonic delivery

257
Q

How much 5ASAs are given for induction of remission?

A

>3g orally per day

258
Q

What is 1st line therapy for UC?

A

5ASA

259
Q

What IBD is 5ASA effective in?

A

UC

260
Q

Why are steroids not long term use for IBD?

A

Adverse side effects

261
Q

Give examples of steroids to induce remission in IBD?

A

Prednisolone
Budesonide

262
Q

What is the optimal dose of prednisolone to give for IBD?

A

40mg a day

263
Q

What immunomodulators are used in IBD?

A

Azathioprine

264
Q

What are the side effects of Azathioprine?

A

Leukopenia
Hepatotoxic
Pancreatitis

265
Q

What is methotrexate used for?

A

Crohn’s

266
Q

What are the risks of methotrexate?

A

10-18% intolerant
Teratogenic

267
Q

What patients are methotrexate used for?

A

Steroid dependant patients

268
Q

Give examples of Anti TNF antibodies used for IBD?

A

Infliximab - 8 weekly IV
Adalimumab - 2 weekly injection

269
Q

Give examples of 4b7 integrins blockers used for IBD?

A

Vedolizumab
8 weekly IV infusions

270
Q

What is tofacitinib an inhibitor of?

A

Pan JAK

271
Q

Describe use of elemental feeding in IBD?

A

Can be as effective as steroids
More efficacious in children

272
Q

When would you operate in an emergency for IBD?

A

Acute severe colitis not responding to therapy
Complications such as perforation, obstruction and abscess

273
Q

When would you electively operate for IBD?

A

Frequent relapses despite medical therapy
Not able to tolerate medical therapy
Steroid dependant
Patient choice

274
Q

What are the options of subtotal colectomy?

A

Pouch procedure
Completion proctectomy

275
Q

How does pouch surgery work?

A

Mobilise and lengthen small bowel
Construct pouch
Insert stapler

276
Q

What are the surgical indications for Crohn’s disease?

A

Failure of medical management
Management of fistula
Failure to thrive
Relief of obstructive symptoms

277
Q

What is the prognosis of functional GI disorders?

A

Long term prognosis good

278
Q

What is the difference between structural and functional GI disorders?

A

Structural has detectable pathology
Functional does not

279
Q

Where can functional GI disorders affect?

A

Whole of GI tract

280
Q

How are most functional GI disorders diagnosed?

A

From history and examination

281
Q

What is non-ulcer dyspepsia?

A

Typical ulcer pain without presence of ulcer

282
Q

What bacteria is needed to be checked in non-ulcer dyspepsia?

A

H pylori

283
Q

What is the treatment for non-ulcer dyspepsia if there is no H.pylori present?

A

Treat symptomatically

284
Q

What is important to ask in the history of a patient presenting with vomiting?

A

Length of time after food

285
Q

What is vomiting and 1 or more after food suggestive of?

A

Pyloric obstruction
Motility disorders

286
Q

f

What is vomiting immediately after food suggestive of?

A

Psychogenic

287
Q

What is vomiting 12 hours after food suggestive of?

A

Obstruction

288
Q

What are the causes of vomiting?

A

Drugs
Pregnancy
Migraine
Cyclical vomiting syndrome
Alcohol

289
Q

When is the onset for cyclical vomiting syndrome?

A

Childhood

290
Q

What are the alarm symptoms for functional GI disorders?

A

Age >50
Short symptom history
Unintentional weight loss
Nocturnal systems
Family history

291
Q

What are the investigations done for functional GI disorders?

A

FBS
Blood glucose
U+ E
Thyroid status
Coeliac serology
FIT
Sigmoidoscopy

292
Q

What are the organic causes of constipation?

A

Strictures
Tumours
Diverticula disease
Proctitis
Anal fissue

293
Q

What are the functional causes of constipation?

A

Mega colon
Idiopathic constipation
Depression
Psychosis

294
Q

What are the systemic causes of constipation?

A

Diabetes
Hypothyroidism
Hypercalcaemia

295
Q

What are the neurogenic causes of constipation?

A

Autonomic neuropathies
Parkinson’s disease
Strokes
MS
Spina bifida

296
Q

What are the clinical features of IBS?

A

Abdominal pain
Altered bowel habit
Abdominal bloating

297
Q

What is the ROME III diagnostic criteria of IBS?

A

Recurrent abdominal pain for >3 days/ months in the past 3 months associated with two or more of
Improvement with dedication
Onset asssocited with changes in stool frequency
Onset associated with change in stool form

298
Q

Where does abdominal pain occasionally radiate to in IBS?

A

Lower back

299
Q

What is the feature present in IBS-C?

A

Constipation

300
Q

What is the feature present in IBS-D?

A

Diarrhoea

301
Q

What is IBS-M?

A

mix of diarrhea/constipation

302
Q

What is bloating in IBS due to?

A

Relaxation in abdominal wall muscles

303
Q

What is seen in the stool in IBS?

A

Mucus

304
Q

What are the investigations done for IBS?

A

Blood
Stool culture
Calprotectin
FIT testing

305
Q

What is calprotectin released by?

A

Inflamed gut mucosa

306
Q

What is calprotectin used for?

A

Differentiating IBS and IBD

307
Q

What makes diarrhoea worse?

A

Tea
Coffee
Alcohol
Sweetener

308
Q

What are the treatment for IBS?

A

Dietetic review
Lactose, gluten exclusion trial
FODMAP

309
Q

What are the drugs used to relieve of diarrhoea in IBS?

A

Antimotlity agents

310
Q

What are the drugs used to relieve pain in IBS?

A

Antispasmodics
Linacloide

311
Q

What are the drugs used to relieve bloating in IBS?

A

Probiotics
Linaclotide

312
Q

What are the drugs used to relieve constipation in IBS?

A

Laxatives
Linaclotide

313
Q

What are the psychological interventions used for IBS?

A

Relaxation training
Hypnotherapy
CBT

314
Q

What may cause IBS?

A

Altered motility
Visceral hypersensitivity
Stress

315
Q

How may intestinal motility cause IBS?

A

In IBS-D muscular contractions may be stronger and more frequent

316
Q

How may gut responses to triggers be altered in IBS?

A

May be stronger in IBS-D or weaker in IBS-C

317
Q

What are the majority of colorectal cancers histologically?

A

Adenocarcinomas

318
Q

What are most colorectal cancers caused by?

A

Sporadic

319
Q

What genes are risk factors for development of colorectal cancer?

A

HNPCC
FAP

320
Q

What are the risk factors for colorectal cancer?

A

Age
Male
Previous adenoma
Environmental

321
Q

What are the environmental influences on colorectal cancer?

A

Diet
Obesity
Lack of exercise
Smoking
Diabetes

322
Q

What are colorectal polyps?

A

Protuberant growth

323
Q

What do the majority of colorectal cancers arise from

A

Pre-existing polyps

324
Q

What do adenoma polyps look like morphologically

A

Peduunculated or sessile

325
Q

What are high-risk features of polyps?

A

Size
Number
Degree of dysplasia
Villous architecture

326
Q

What oncogenes promote cell growth?

A

K-ras
C-myc

327
Q

What causes cell growth leading to colorectal cancer?

A

Activation of oncogenes
Loss of tumour suppressor gene
Defective DNA repair pathway genes

328
Q

Give examples of tumour suppressor genes that may be lost giving rise to colorectal cancer?

A

APC
P53
DCC

329
Q

What are the symptoms of colorectal cancer?

A

Rectal bleeding
Altered bowel opening to loose stools >4 weeks
Iron deficiency anemia

330
Q

What is a sign that the colorectal cancer tumour is stenosing?

A

Acute colonic obstruction

331
Q

What are the systemic symptoms of malignancy?

A

Weight loss
Anorexia

332
Q

What is the investigation of chose for colorectal cancer?

A

Colonoscopy

333
Q

What are the disadvantages of colonoscopy?

A

Sedation
Bowel preparation

334
Q

What are the risks of colonoscopy?

A

Perforation
Bleeding

335
Q

What is the radiological imaging investigation of choice for colorectal cancer?

A

CT colonoscopy

336
Q

What are the staging investigations done for colorectal cancer?

A

CT scan
MRI
PET

337
Q

What percentage of patients with colorectal cancer will have surgery?

A

80%

338
Q

When would endoscopic or local resection be offered to treat colorectal cancer?

A

Dukes A and cancer polyps

339
Q

What is formed during colorectal cancer surgery?

A

Stoma formation

340
Q

What is removed during colorectal cancer surgery?

A

Lymph nodes
Liver for metastasis

341
Q

When would chemotherapy be given in colorectal cancer?

A

Dukes C
Adjuvant

342
Q

What is the reason chemotherapy is given after colorectal cancer surgery?

A

Mops up micrometastases

343
Q

When would radiotherapy be given for colorectal cancer?

A

Neoadjuant
Rectal cancer only

344
Q

What test is now done for screening colorectal cancer?

A

FIT test

345
Q

What are the benefits of FIT screening over the Scottish bowel screening program?

A

Provides flexibility to alter the cut off to accomate risk factors inducing age and gender

346
Q

What high risk groups are screened for colorectal cancer?

A

Heritable groups
IBD
Familial risk
Previous adenoma/ colorectal cancer

347
Q

What age is invited to bowel screening?

A

50-74 years

348
Q

What type of condition if FAP?

A

Autosomal dominant

349
Q

What is FAP due to?

A

Mutations of the APC gene on chromosome 5

350
Q

What is given to those with the FAP gene to reduce their risk of getting colorectal cancer?

A

Annual colonoscopy from age 10-12
Prophylactic proctocolectomy age 16-35 years

351
Q

What type of condition is MAP?

A

Autosomal recessive

352
Q

what is MAP caused by

A

Pathogenic variants in the MUTYH base excision repair gene

353
Q

What side is CRC most likely to be on if due to MAP?

A

Right

354
Q

What is done for those who have MAP gene to reduce their risk of CRC?

A

Upper GI surveillance starting age 35
Annular colorectal surveillance from 18-20 years

355
Q

What is HNPCC due to?

A

Mutation in DNA mismatch repair genes

356
Q

What type of condition is HNPCC?

A

Autosomal dominant

357
Q

What do tumours caused by HNPCC typically have?

A

Microsatellite instability

358
Q

What age do people with HNPCC gene get screening for CRC from?

A

25
2-year colonoscopy

359
Q

What are the functions of the colon?

A

Water and electrolytes absorption
Production and absorption of vitamins
Storage of faeces
Hosts gut microbiota

360
Q

What vitamins does the colon absorb?

A

K and B

361
Q

What are the factors that ensure anorectal continence?

A

Anorectal sensation
Central control
Stool consistency
Renal compliance

362
Q

Give examples of types of polyps?

A

Flat
GI rant
Pedunucalated

363
Q

What is the protocol for a patient coming in with low-risk features of rectal bleeding lasting less than 6 weeks?

A

Watch and wait for 6 weeks before reviewing

364
Q

What is the gold standard investigation done for colorectal cancer?

A

Colonoscopy +/- biopsies

365
Q

What radiological imaging is done for suspected colorectal cancer?

A

CT colongraphy
Plain CT with contract

366
Q

Where are most colorectal cancers found?

A

Proximal colon

367
Q

Why is MRI important in rectal cancer?

A

Could dictate if neoadjuvant chemotherapy/radiotherapy is needed

368
Q

What is needed to be recessed to reside local recurrence rate in rectal cancer?

A

Rectum and surrounding me sore Tim

369
Q

What is the rectum surrounded by?

A

Mesorectum
Contains all lymph nodes of rectum

370
Q

How long is surgery after neoadjuvant treatment for rectal cancer?

A

8-10 weeks

371
Q

What are the principles for bowel anastomoses?

A

Tension free
Well perfused
Well oxygenated
Clean surgical site
Acceptable systemic state

372
Q

where are ileostomies typically located?

A

Right iliac fossa

373
Q

Where are colostomies located?

A

Left iliac fossa

374
Q

Describe the apperance of an ileostomy

A

Spouted

375
Q

Describe the appearance of a colostomy?

A

No spout
Flush with skin

376
Q

What is the contents of an ileostomy?

A

Liquid
Looser stools

377
Q

What are the contents of a colostomy?

A

Solid stools

378
Q

What are the complications of rectal surgery?

A

Bleeding
Infection
Anastomotic leak
Stoma problems

379
Q

What are the complications in lower anterior resections?

A

Damage to pelvic nerves
Impaired fecundity in younger women

380
Q

What may be required post-op in rectal surgery?

A

Adjuvant chemotherapy

381
Q

What are the signs of bowel obstruction?

A

Abdominal pain
Vomiting
Absolute constipation
Abdominal distension

382
Q

When would vomiting occur in bowel obstruction?

A

If ileocaecal valve is not competent

383
Q

What are the causes of large bowel obstruction?

A

Malignant
Strictures
Volvulis
Faecal impact ion

384
Q

What investigations are done for bowel obstruction?

A

CT
Blood gase
Bloods

385
Q

What are the nutritional needs of someone presenting with bowel obstruction?

A

NBM
Nasogastric tube if vomiting
fluid resucitation

386
Q

What is the medical management of bowel obstruction?

A

Analgesia
Antiemetic
IV antibiotics

387
Q

What is the function of the anorectum?

A

Control of defaecation
Maintenance of continence

388
Q

What does the anorectum require in order to carry out its functions?

A

Pelvic floor
Rectal compliance
Intact pelvic neurology

389
Q

What are the surgical treatments for haemorrhoids?

A

HALA
Anopexy
Haemorrhoidectomy

390
Q

What are the characteristics of haemorrhoids?

A

Bleeding
Painless
Straining

391
Q

What are the underlying causes of haemorrhoids?

A

Constipation

392
Q

What is the OPD treatment for haemorrhoids?

A

Rubber band ligation

393
Q

What is the characteristic of a fissure?

A

Pain
Bleeding
Glass splinters

394
Q

What is the medical management for fissures?

A

GTN/ Diltiazem + Lignocaine

395
Q

What are the surgical treatments for fissures?

A

Botox
Sphinncterotomy

396
Q

What are the symptoms of a perianal abscess?

A

Excruciating pain
Signs of sepsis

397
Q

When would you give antibiotics for a perianal abscess?

A

If septic

398
Q

What are the risk factors for perianal abscess?

A

Diabetes
BMI
Immunosuppression
Trauma

399
Q

What is the treatment for perianal abscess?

A

Incision and drainage

400
Q

What are the symptoms of a fistula in ano?

A

Peri-anal sepsis
Persistent pus discharge with flare up
+/- faecal soiling

401
Q

What is the failure rate of surgery for a fistula in ano?

A

50%

402
Q

Name the treatments for fistula in ano?

A

Seton
Sphincter preservation techniques
Lay open

403
Q

Why should a lay open not be done on women?

A

Due to thinner muscular walls

404
Q

What test is positive when there is rectal cancer present?

A

FIT test

405
Q

What are the routine investigations for rectal cancer?

A

PR examination
Proctoscopy
Rigid sigmoidoscopy
Colonoscopy

406
Q

What are the imaging investigations for rectal cancer?

A

CT colonoscopy
CT scan
MRI rectum

407
Q

What is pelvic floor dysfunction?

A

Collection of wide spectrum of symptoms related to defection

408
Q

What are the categories of causes of pelvic floor dysfunction?

A

Child birth-related
All other causes - surgery, abuse etc

409
Q

Who does pelvic floor dysfunction primarily affect?

A

Parous women

410
Q

What are the causes of pelvic floor dysfunction in non-parlours women and men?

A

Surgical misadventure
Neurological/ connective tissue disorders
Psychological/ behavioural issues

411
Q

Name the types of chronic constipation

A

Dietary
Drugs
Organic
Functional

412
Q

Name the types of functional chronic constipation?

A

Slow transit
Evacuation related
Combination

413
Q

Give examples of drugs that can cause constipation

A

Opioids
Verapamil
Diuretics

414
Q

What investigations are done for chronic constipation to exclude sinister pathology?

A

Colonic imaging
Bloods
Symptomatic qFIT
Coeliac serology
Faecal calprotectin

415
Q

What are first-line drugs for chronic constipation?

A

Regular baseline laxatives

416
Q

Name the second-line drugs for chronic constipation?

A

Prucalopride
Lubiprostone
Linaclotine

417
Q

What second-line drug for chronic constipation is for women only?

A

Proculopride

418
Q

When would you give second-line drugs for chronic constipation?

A

Failure treatment with 2 or more regular laxatives from different classes at highest dose for 6 months and invasive measures considered

419
Q

What are the surgical options for slow transit chronic constipation?

A

Subtotal colectomy with end ileostomy
Subtotal colectomy with ileorectal anastomoses

420
Q

What are the other management options for chronic constipation?

A

Persistent irrigation system
Qufora irrigation

421
Q

Name the types of faecal incontinence?

A

Passive
Urge
Mixed
Overflow

422
Q

What investigations may be done for faecal incontinence?

A

Endo-anal USS
Defaecatory proctogram

423
Q

what does an anal manometry measure?

A

Anal sphincter function
Length of the anal canal
Changes in anal pressure during the dedication
Recto-anal inhibitory reflex
Anorectal pressure responses

424
Q

What may recto-anal inhibitory reflex be used to detect?

A

Congenital Hirshsprung
Systemic sclerosis

425
Q

What does the defaecating proctogram provide information on?

A

Pelvic floor mobility
The pathological function of the musculature
Changes to form and axis or organs
Internal hernias

426
Q

What are the non-pharmacological treatments of FI?

A

Low fibre diet
Pelvic floor exercises
Anal plug

427
Q

What are the pharmacological treatments of FI?

A

Loperamide
Irrigation

428
Q

What are the surgical treatments of FI?

A

Sphincter repair
Correct anatomical defect
Sacral nerve stimulator

429
Q

What is rectocoel?

A

Passive loss of stool from being trapped due to incomplete evacuation

430
Q

What is the treatment for internal rectal prolapse?

A

Improve rectal evacuation
Enemas
Loperamide

431
Q

What is the choice of operation for rectal prolapse in a fit patient?

A

Rectopexy

GI Alimentary Year 2 Medicine (7 decks)

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