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Finals > Gastro > Flashcards

Gastro Flashcards

1
Q

What are the differences between Crohn’s and UC?

A

In Crohn’s:
Less common to have blood or mucus in stool
Entire GI tract is affected unlike UC where it is colon and rectum
Skip lesions on endoscopy unlike UC where there is continuous inflammation
Terminal ileum most affected
Transmural inflammation unlike UC where inflammation only in superficial mucosa
Smoking is risk factor where it is protective in UC
Strictures and fistulas are present

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2
Q

What are the presenting features of IBD?

A

Diarrhoea, abdominal pain, rectal bleeding, fatigue, weight loss, faecal urgency, nocturnal defecation, tenesmus, clubbing, mouth ulcers

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3
Q

What diseases are associated with IBD?

A

Erythema nodosum, pyoderma gangrenosum, eneteropathic arthritis, primary sclerosing cholangitis, red eye condiitons e.g. episcelritis, scleritis, anterior uveitis

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4
Q

What investigations should initially be performed in patient presenting with IBD symptoms?

A

FBC, inflammatory markers, haematinics, U+E, LFTs, TFTs, anti-TTG (rule out coeliac), stool microscopy (rule out infection), faecal calprotectin (1st line)

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5
Q

What is the gold standard investigation for diagnosing IBD?

A

Colonoscopy with multiple intestinal biopsies

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6
Q

What is the management for acute mild UC?

A

1st line = Aminosalicylates - topical then oral (unless extensive disease when oral first)

2nd line = oral prednisolone

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7
Q

What is the management for acute severe UC?

A

1st line = IV hydrocortisone
2nd line = IV ciclosporin
3rd line = infliximab or surgery

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8
Q

How is remission maintained in UC?

A

1st line = aminosalicylates
2nd line = azathioprine or mercaptopurine
3rd line = methotrexate

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9
Q

How is remission induced in Crohn’s?

A

1st line = steroids PO/IV depending on severity
Enteral nutrition
2nd line = steroids + another immunosuppressant medication

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10
Q

What is used to maintain remission in Crohn’s?

A

1st line = azathioprine, mercaptopurine
2nd line = methotrexate

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11
Q

What are people with IBD at risk of developing?

A

Bowel cancer
Osteoporosis

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12
Q

What are the symptoms of IBS?

A

Abdominal pain, diarrhoea, constiption, fluctuating bowel habit, bloating, worse after eating, improved by opening bowels, straining - symptoms often triggered by something

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13
Q

What investigations need to be done to diagnose IBS?

A

All results will be normal in IBS
FBC, inflammatory markers, coeliac serology, faecal calprotectin, CA125

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14
Q

What criteria is used to help diagnose IBS?

A

Rome IV criteria

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15
Q

What lifestyle advise can be given to patients with IBS?

A

Regular small meals, adjust fibre intake, limit caffeine/alcohol/fatty foods, low FODMAP, regular exercise, reduce stress

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16
Q

What is 1st line antidiarrhoeal and laxative in IBS?

A

Loperamide for diarrhoea
Ispaghula husk and other bulk forming laxatives

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17
Q

What autoantibodies are associated with coeliac disease?

A

Anti-TTG, anti-EMA, anti-DGP

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18
Q

Which part of the bowel is most affected in coeliac disease?

A

Jejunum in small intestine

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19
Q

What is the presentation of someone with coeliac disease

A

Failure to thrive, diarrhoea, bloating, steatorrhoea, weight loss, mouth ulcers, dermatitis herptiformis, anaemia

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20
Q

How long do patients need to be eating gluten for before testing for coeliac serology?

A

6 weeks

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21
Q

What is the 1st line investigation for coeliac disease?

A

Total IgA and anti-TTG

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22
Q

What is the gold standard investigation for coeliac disease and what is seen?

A

Endoscopy and jejunal biopsy - crypt hyperplasia and villous atrophy

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23
Q

What are the complications of coeliac disease?

A

Nutritional deficiencies, anaemia, osteoporosis, hyposplenism, ulcerative jejunitis, non-hodgkin lymphoma

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24
Q

What are the symptoms of GORD?

A

Heartburn, acid reflux, retrosternal or epigastric pain, bloating, nocturnal cough, hoarse voice

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25
Q

What are the 2ww referral criteria for urgent endoscopy?

A

Difficulty swallowing

> 55 AND weight loss, upper abdo pain, reflux, treatment resistant symptoms, N+V, upper abdo mass, anaemia, rasied platelet count

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26
Q

What is a hiatus hernia?

A

Herniation of the stomach up through the diaphragm, allows contents of stomach to reflux into oesophagus very easily

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27
Q

What are the best investigations to diagnose hiatus hernia?

A

CXR, CT scan, endoscopy, barium swallow test

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28
Q

What lifestyle advice can be given to someone with GORD?

A

Reduce tea/coffee/alcohol, weight loss, avoid smoking, smaller meals, avoid heavy meals before bedtime, stay upright after meals

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29
Q

What medications can be used to treat GORD?

A

Antacids (e.g. Gaviscon), PPI (e.g. omeprazole), H2 receptor antagonists (e.g. famotidine)

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30
Q

When should a H.pylori test be offered to someone?

A

Should be offered to anyone with dyspepsia - need 2 weeks without using PPI before testing

Always consider testing in treatment resistant symptoms

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31
Q

What is the treatment for H.pylori infection?

A

PPI + two antibiotics

e.g. amoxicillin + clarithromycin

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32
Q

What change occurs in the epithelium in Barrett’s oesophagus?

A

Metaplasia from squamous (oesophagus) to columnar epithelium (stomach epithelium)

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33
Q

What treatment can be done in Barrett’s oesophagus to prevent development into adenocarcinoma?

A

Endoscopic ablation

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34
Q

What is Zollinger-Ellison syndrome ?

A

Rare condition in which duodenal and pancreatic tumours secrete excessive gastrin –> GORD

Associated with multiple endocrine neoplasia type 1

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35
Q

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

A

Adenocarcinoma in lower 1/3 of oesophagus

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36
Q

What is the treatment for oesophageal and stomach cancer?

A

Surgical resection and adjuvant chemotherapy

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37
Q

What is the investigation of choice for diagnosing stomach cancer and what is seen?

A

Endoscopy and biopsy
Signet ring cells may be seen

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38
Q

What are the two genetic conditions associated with increased risk of bowel cancer?

A

Famiilial adenomatous polyposis
Hereditary nonpolyposis colorectal cancer (Lynch syndrome) = most common and also associated with endometrial cancer

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39
Q

What are the 2ww criteria for suspected bowel cancer?

A

Over 40 with abdo pain and weight loss

Over 50 with unexplained rectal bleeding

Over 60 with change in bowel habit or iron deficiency anaemia

Positive FIT test

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40
Q

What test is used in bowel cancer screening and when is bowel cancer screening used?

A

FIT test

Done in those aged 60-74 every 2 years

If positive send for colonoscopy

41
Q

What is the tumour marker associated with bowel cancer?

A

CEA (not useful in diagnosis but used in follow up after cancer diagnosis)

42
Q

What are the risk factors for peptic ulcers?

A

H.pylori, NSAIDs, alcohol, caffeine, smoking, spicy foods, SSRIs, steroids

43
Q

What pain is associated with gastric and duodenal ulcers ?

A

Epigastric pain
Gastric - worse when eating
Duodenal - 2-3 hours after eating that it presents

44
Q

What is the management for peptic ulcers?

A

Stop any offending medication
Treat H.pylori infection if present
PPI
Repeat endoscopy to ensure they heal

45
Q

What complications can occur due to peptic ulcers?

A

Bleeding, perforation, gastric outlet obstruction

46
Q

What are the presenting features of appendicitis?

A

Abdominal pain - starts central and moves down to McBurney’s point
Anorexia, N+V, low grade fever, constipation, abdominal distention, guarding, rebound tenderness, percussion tenderness

47
Q

What is Rosving’s sign?

A

Palpation of the LIF causes pain in the RIF

48
Q

What is psoas sign?

A

Passive extension of the right thigh with the person in left lateral position elicits pain in right lower quadrant

49
Q

What is obturator sign?

A

Passive internal rotation of the flexed right thigh elicits pain in the right lower quadrant

50
Q

What are the differential diagnoses for appendicitis?

A

Ectopic pregnancy, ovarian cysts, Meckel’s diverticulum, mesenteric adenitis, testicular torsion, incarcerated hernia (groin should always be examined)

51
Q

What are the risk factors for developing diverticular disease?

A

Low fibre diet, obesity, use of NSAIDs

52
Q

What laxative should be used in diverticular disease?

A

Bull-forming laxatives e.g. ispaghula husk

AVOID stimulant laxatives

53
Q

What are the key presenting features of diverticulitis?

A

Pain in left iliac fossa, fever, diarrhoea, N+V, rectal bleeding, palpable abdominal mass, raised inflammatory markers

54
Q

What is the management of uncomplicated diverticulitis? (in GP)

A

Oral co-amoxiclav, analgesia, only take clear liquids, follow up to review

55
Q

What is the management of severe diverticulitis? (in secondary care)

A

Nil by mouth, IV antibiotics, IV fluids, analgesia, urgent investigations

56
Q

Which is more common small bowel obstruction or large?

A

SBO

57
Q

What are the causes of small bowel obstruction?

A

Adhesions, hernias, strictures, intussception

58
Q

What are the causes of large bowel obstruction?

A

Malignancy, volvulus, diverticular disease

59
Q

What is the presentation of bowel obstruction?

A

Vomiting (billous vomiting), abdominal distention, diffuse abdominal pain, absolute constipation, lack of flatulence

60
Q

What is the management for bowel obstruction?

A

Nil by mouth, IV fluids to hydrate, NG tube with free drainage to allow stomach contents to freely drain

Surgery to correct underlying cause

61
Q

What is ileus?

A

Normal peristalsis that pushes the contents along the length of the intestines temporarily stops due to bowel surgery/injury

62
Q

What are the symptoms of ileus?

A

Bilious vomiting, abdominal distention, diffuse abdominal pain, absolute constipation and lack of flatulence, absent bowel sounds

63
Q

What is the management of ileus?

A

Supportive care - nil by mouth, NG tube, IV fluids, mobilisation, TPN

64
Q

Where is the most common location for volvulus?

A

Sigmoid colon

65
Q

What are the risk factors for volvulus?

A

Chronic constipation, nursing home residents, high fibre diet, pregnancy, adhesions

66
Q

What is seen on an abdominal XR of someone with sigmoid volvulus?

A

Coffee bean sign

67
Q

What investigation is required to diagnose volvulus?

A

Contrast CT abdomen/pelvis

68
Q

What is the management of volvulus?

A

Supportive care

Endoscopic decompression can be attempted - flexible sigmoidoscope inserted

Surgery - Hartmann’s procedure (sigmoid), ileocaecal resection (caecal)

69
Q

What are the causes of upper GI bleed?

A

Peptic ulcers (most common), mallory-weiss tear, oesophageal varices, stomach cancers

70
Q

What is the presentation of upper GI bleed?

A

Haematesmesis, coffee ground vomit, melaena

71
Q

What scoring system is used in those with suspected upper GI bleed?

A

Glasgow-Blatchford bleeding score - a score above 0 = high risk of bleeding

72
Q

What scoring system is used post endosocpy to estimate risk of rebleeding and mortality in upper GI bleed?

A

Rockall score

73
Q

What is the management of upper GI bleed?

A

ABCDE
Bloods - high urea in upper GI bleeds, crossmatch
Transfusions - blood, platelets and clotting factors
If due to oesophageal varices - terlipressin and broad spectrum antibiotics
OGD within 24 hours - diagnose and treat the source of bleeding

74
Q

What medication can be used as prophlyaxis of oesophageal bleeding in those with GI bleed?

A

Non-cardioselective beta blockers e.g. propranolol

75
Q

What causes chronic mesenteric ischaemia?

A

Narrowing of the mesenteric blood vessels by atherosclerosis (intestinal angina)

76
Q

What are the classic triad of signs/symptoms associated with chronic mesenteric ischaemia?

A

Central colicky abdominal pain after eating
Weight loss
Abdominal bruit

77
Q

What is the management of chronic mesenteric ischaemia?

A

CT angiography to diagnose
Secondary prevention and reduction in risk factors
Revascularisation to improve blood flow to intestines

78
Q

What is acute mesenteric ischaemia?

A

Caused by rapid blockage in blood flow through the mesenteric artery - usually a thrombus

79
Q

What is a key risk factor for acute mesenteric ischaemia?

A

AF

80
Q

What are the presenting features of acute mesenteric ischaemia?

A

Acute, non-specific abdominal pain (pain disproportionate to examination findings), shock, peritonitis and sepsis

81
Q

What is the investigation of choice in acute mesenteric ischaemia?

A

Contrast CT

82
Q

What is the management of acute mesenteric ischaemia?

A

Surgery to remove necrotic bowel and remove thrombus in the blood vessel

83
Q

What are the risk factors for developing haemorrhoids?

A

Constipation, straining, pregnancy, obesity, increased age

84
Q

What are the symptoms associated with haemorrhoids?

A

Painless bright red bleeding typically on tissue, sore/itchy anus, feeling lump around anus

85
Q

What is the stepwise management for haemorrhoids?

A

Lifestyle advice
1. Topical treatments - anusol
2. Rubber band ligation
3. Surgery e.g. hamorrhoid artery ligation or removal

86
Q

What is the presentation of anal fissure?

A

Painful bright red rectal bleeding

87
Q

What is the management of anal fissure?

A

High fibre diet and bulk forming laxatives

If chronic topical GTN followed by surgery

88
Q

What are the symptoms of pilonidal sinus abscess?

A

Pain, discharge, swelling at site

Cycles of being asymptomatic and periods of pain and discharge

89
Q

What is the management of pilonidal sinus abscesses?

A

If asymptomatic - no management required
If acute - incision and drainage
If chronic - excision of pits and obliteration of underlying cavity

90
Q

What are the complications associated with hernias and what do they mean?

A

Incarceration - where the hernia cannot be reduced back into the proper position

Obstruction - when hernia causes of blockage in passage of faeces

Strangulation - hernia is non-reducible and base of hernia is tight and blood supply is cut off (painful)

91
Q

When is conservative management appropriate with hernias?

A

When the hernia has a wide neck (less complications) and patient has significant morbidities

92
Q

How is a hernia repaired surgically?

A

Tension-free repair - mesh over the defect in the abdominal wall

93
Q

What is an indirect inguinal hernia?

A

Bowel herniates through inguinal canal/tract, consequence of deep inguinal ring not shutting after the testes have descended through it during foetal development

94
Q

What is a direct inguinal hernia?

A

Occurs due to weakness in abdominal wall, hernia protrudes directly through abdominal wall and not along tract

95
Q

What is a femoral hernia?

A

Herniation of abdominal contents through femoral canal

Have narrow opening making femoral hernias high risk for complications

96
Q

What is seen on histology in Crohn’s disease?

A

Granulomas and increased goblet cells

97
Q

What is seen on histology in UC?

A

Crypt abscesses, depletion of goblet cells

98
Q

How does oesophageal rupture present?

A

Emphysema in neck, vomiting and chest pain after eating

Finals (21 decks)

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