gast path lumen Flashcards
buzzword for allergic opesophagitis
feline or corrugated/spotty oesophagus
treatment of allergic oesophagitis
steroids/montelukast/ sodium cromoglicate
associations of squamous cell carcinoma of oesophagus (not barrets assoc)
vit A/ZINC deficiency
HPV
Smoking
what type of Ig is produced in H.pylori infection
IgA
treatment of barrets oesophagus
radiofrequency ablation - 1st line
resection if high grade
how does h.pylori survive in the gastric environment - whta mechanisms
chemotaxis away from low pH areas, using its flagella to burrow into the mucous lining to reach the epithelial cells underneath
secretes urease → urea converted to NH3 → alkalinization of acidic environment → increased bacterial survival
how does h.pylori cause disease
releases CagA toxin that disrupts the gastric mucosa
associations of h.pylori - what does it casue
peptic ulcer
gastric cancer
b cell MALT lymphoma
atrophic gastritis
what % of duodenal ulcers does h.pylori cause
95%
managemnet of h.pylori infection (+ pen allergic) and time duration
7 days
PPI + AMOX + (CLARY or MET)
pen allergic = PPI + CLARY+ MET
in urease breath test how long after drinking solution if test performed
30 mins
how long shoudl PPI be stopped for before commencing urease breath test
2 weeks
what test is used to indetify h.pylori infection
CLO test (rapid urease test)
breath test checks for eradication
what particular lymph nodes may been seen in gastric cancer if lymphatic spread
virchows node- left supraclavicular
sister mary joseph node - peri-umbilical
diagnostic test for gastric cancer
OGD with biopsy
what cells would you expect to see in gastric cancer biopsy
signet ring cells due to large mucin vaculoe pushing nucleus to the side
what infection is assoicated with a gastric MALT tumour
h.pylori
casues of gastroparesis
idiopathic
cannabis
diabetic neuropathy
opiates
treatment of gastroparesis
food little and ofte
metoclopramid
castric pacemakes
features of achalasia
dysphagia to BOTH liquid and food
variation in symptom severity
heartburn
regurg of food
diagnostic test in achalasia
oesophageal manometry
first line treatment of achalasia
pneumatic balloon dilatation
if first line treatment for achalasia doesnt succeed what surgicla intervention is available
heller cardiomyotomy
most common cause of GI bleed
duodenal ulcer
what is the rockall score used for
moratality of gi bleed
what is blatchford score used for
likelyhood of gi rebleed
treatment of peptic ulcer
- adrenaline into ulcer to cause vasoconstriction
- heater probe coag
- clips
4.haemospray
what is given post endoscopic intervention in peptic ulcer
PPI AND H.PYLORI ERADICATION
treatment of variceal bleed pre-endoscopy
ABCDE - resus before endoscopy
clotting factors
Terlipressin
prophylactiv IV -quinolones
what shoudl be given BEFORE endoscopy in variceal bleed
Terlipressin and ABX
treatment of variceal bleed in endoscopy
band ligation and sclerotherpay
options of variceal bleed treatment if endoscopy tx failed or not feasible
sengstak-blakemore tube
TIPPS procedure
what is involved in a TIPPS procedure
Transjugular intrahepatic portosystemic shunt-
a shunt/stent is placed to attached portal veins to systemic- heaptic vein (bypassing liver) to reduce pressure
complication of TIPPS procedure
exacerbation of hepatic encephalotpathy
prophylactic management of variceal bleed
propanalol
band ligation
for prophylactic band ligation of oesophageal varices how often is this performed and what medication is given
performed every 2 weeks and a PPI id given to preveent ulcer
what length of bowel is classed as short gut
<200cm
normal length of small bowel
6-7m
what type of intestinal failure is short bowel syndrome
type 3
investigation of choice for suspected bowel ischamia
CT
thumbing printing and ischaemic abdo pain
ischaemic colitis
cause of mesenteric ischaemia
emboli
which type of bowel ischaemia causes bloody diarrhoea
ischaemic colitis
cause of ischaemic collitis in younger adults
cocaine use
what investigation findings would you expect in a lower GI tract ischaemia
raised WCC and lactic acidosis
treamtnet of acute mesenteric ischaemia
laparotomy
what type of IBD causes inflammation through all layers
Chrons
in chrons transmural inflammation - what does this predispose individuals to
strictures
fistula
adhesions
what presents wiht peir-anal disease chrons or UC
chrons
what IBD is granulomatous
Chrons
whch IBD has the higher cancer ris
UC
which IBD would show thumbprinting on X-ray
UC
which IBD is assoc with psuedopolyps
UC
what is the most common extra-intestinal feature of Chrons and UC
Arthritis
PSC is more related to which IBD
UC
describes the common eye features of chrons and uc respectively
Chrons - episcelritis
UC - uveitis
what skin manifstations are assoc with IBD
pyoderma gangrenosum and erythema nodosum
which IBD is assoc with crypt abscesses
UC
features of UC
abdo pain partic LIF
urgency
bloody diarrhoea
tenesmus
features of chrons
abdo pain
weight loss
diarrhoea
peri-anal disease
loss of haustra markings IBD
UC
what blood test is a good marker of disease activity in chrons
CRP
what is the investigation of choice for chrons
colonoscopy and biopsy
what should be done in UC in a flare of colitis instead of colonoscopy adn why
flexi sig as colonscopy may casue perforation
goblet cells on histology would be indicative of what IBD
chrons
what secondary investigation is good for IBD after colonscopy
barium enema
what would barium enema show in UC
loss of haustra,
pseudopolyps
drainpipe colon
what is kantor strign sign ? when and why is it seen
seen on barium enema in chrons diease
looks like beads on long string- with the sting beinglong segments of strictures from disease
what IBD are rose thorn ulcers seen
Chrons
relationship between smoking and IBD
worsens Chrons protective for UC
what faecal test can be done in IBD
faceal calprotectin
what test shoudl be done before starting azathioprine or metocarpurine
TPMT
treatment of parianal abscess in chrons
incision and drainage
what drugs are used to maintain remission in chrons
azzathiprine or mercaptopurine
what is the investigation of choice for suspected peri-anal fistula in chrons
MRI
treatment for symptomatic peri-anal fistula in chrons
oral metronidazole
durgical options in UC
permanent ileostomy or
restorative proctocoloectomy and J pouch
