Gastro Flashcards
1
Q
Approx length of oesophagus?
A
25cm
2
Q
Upper sphincter of Oesophagus =?
A
cricopharyngeal
3
Q
Where are the distal 1-2cm of oesophagus located?
A
below diaphragm
4
Q
Lining of most distal oesophagus = ?
A
Glandular (columnar) mucosa
5
Q
Where is squamo columnar junction usually located?
A
40cm from incisors
6
Q
Most common form of oesophagitis?
A
Reflux oesophagitis
7
Q
Risks for reflux?
A
Defective sphincter
Hiatus hernia
Increased abdo pressure
increase gastric fluid (outflow stenosis)
8
Q
Strangulation is associated with which hiatus hernia?
A
Paraoesophageal
9
Q
Type of hiatus hernia causing heartburn?
A
Sliding hiatus
10
Q
Histological features of reflux?
A
basal cell hyperplasia, increased desquamation. infiltration of inflammatory cells
11
Q
Cause of barretts oesophagus?
A
Longstanding reflux
12
Q
Risk factors for barrets?
A
As normal reflux (male, overweight and caucasian)
13
Q
Histology of barrets?
A
Glandular metaplasia (squamous replaced by columnar)
14
Q
Is barretts pre-malignant?
A
Yes! surveillance useful
15
Q
Barrets eventually may lead to what?
A
Adenocarcinoma
16
Q
Two types of oesophageal cancer…?
A
Adeno and squamous
17
Q
Uk has lower incidnce of what type of oesopho cancer than the other/other countries?
A
Squamous 30%
18
Q
Male or femal more likely to get adenocarcinoma of oesophagus?
A
Male 7:1
19
Q
Risk for squamous carcinoma of oesophagus?
A
Black, male, hpv, hot drinks!
20
Q
Squamous higher or lower than adenocarcinoma in oesophagus?
A
Usually higher up
21
Q
TNM staging uses what?
A
pT depth of primary invasion
22
Q
pT stages?
A
1= lamina, submucos 2= muscularis 3= adventitia 4= adjacent structures
23
Q
Node staging in oesophageal cancer?
A
1= 1 or 2 2= 3-6 3= 7+
24
Q
Metastasis grading in oesophagus?
A
M0 is none M1 = some!
25
Causes of chronic gastritis?
H.pylori
chemical
Nsaid
Bile reflux and alcohol
26
Pylori, talk to me gram etc?
Gram neg, flagellae, lives on epithelium
27
Where is h.pylori more common in stomach?
Antrum
28
Major sites for peptic ulcers?
Duodenum first part, antral body, distal oesophagus
29
Histology of gastric ulcer?
full thickness coagulative, ulcer and granulation
30
H.pylori more associated with gastric or duodenal?
Duodenal
31
Duodenal or gastric ulcers are more likely?
Duodenal 3:1
32
Duodenal or gastric ulcer in younger?
Duodenal
33
Most frequent gastric cancer type?
Adeno
34
Aetiology of gastric cancer?
Diet(smoked food pickled)
H.pylori
bile reflux
Low pH
35
Carcinoma of GOJ increase or decrease recent and associated with?
Increase and in white males. no diet assoc or h.pylori, is assoc with reflux
36
Body and antrum of stomach cancer associations?
Diet assocaited, h.pylori but no reflux assoc
37
Mutation in what = HDGC hereditary gastric cancer ?
Cadherin
38
What causes the issue in gluten intolerant people?
Gliadin, cells express IL15
39
IL15 induces activation of what?
CD8= cells kill enterocytes
40
Mechanism of coeliac disease?
Not CD8 but IL15 expression from gliadin
41
Coleiac assocaited with what? (10%)
Dematitis herpeformis
42
Test for coeliac?
TTG Transglutaminase
43
What is diagnostic for coeliac?
Only a biopsy
44
Where are diverticulum most common?
Sigmoid colon
45
Diverticular in colon or mostly acquired or congenital?
Acquired
46
Where are the diverticular in the sigmoid?
Between mesenteric and antimesenteric taeni coli
47
Diet protection in divertucla disease?
High fibre
48
Diverticular sex distribution?
Equal
49
Why do diverticula form?
Increased pressure pushes out loops
50
Histological diverticular problems?
Thickening of muscularis, elastosis of taenei coli
51
Chronic complications of diverticulosis?
Stricture, fistula, or colitis
52
Most common colitis bacteria?
Camplylobacter and salmonella
53
Idiopathic imflammatory bowel disease=?
UC and chrons or indeterminate
54
Peak age of IBD onset?
20-40
55
Crohns mor common in who?
Females slightly
56
Risk factors for IBD?
Smoking, oral contraceptive although smoking protective against UC
57
Appendicectomy in childhood protective against?
Crohns
58
Strong genetic element in which?
Crohns
59
Narrowing is rare in which IBD?
UC
60
UC inflammation restricted to which layers?
Superficial
61
Crohns affects where?
All of the tract
62
which ibd is full thickness?(transmural)
Crohns
63
Most common place for crohns?
Ileocolic
64
Crohns is patchy or continuous?
patchy
65
Fistulae seen in which IBD?
crohns
66
Rectum always involved?
UC
67
Granulomas present in which ibd?
Crohns
68
Cancer incidence in IUC?
After a long time >10yrs
69
What is a polyp?
Submucosal protrusion
70
hamartomatous polyps?
Peutz jeghers and juvenile
71
Muco-cutaneous pigmentation in which syndrome?
peutz jeghers
72
80% of adenomas n small bowel do what?
Progress to carcinoma in 10-15years
73
% penetrance for cancer in FAP?
100% lifetime
74
FAP due to mutation where?
APC supressor gene
75
HNPCC cause?
DNA mismatch problem
76
HNPCC other cancers?
Ovarian endomtrial urinary
77
Bowel cancer often
| spreads where haematogenously?
Liver and lungs
78
Most bowel cancers are of what type?
Adenocarcinoma
79
Most colorectal cancers fall into which grading category?
Moderately differentiated (60-80%)
80
Which staging often used for bowels?
Dukes
81
Nodal staging for bowel ?
N0 = none
N1= 1-3
N2=4+
82
Stage A dukes?
Confined to bowel wall no lymph nodes
83
Dukes Stage B?
Invading through wall but no lymph involvement
84
Dukes stage C?
Regional metastasis of lymph nodes
85
Dukes D?
Distant metastasis
86
Most tumours are dukes ...?
C survival of approx 40-50% 5 yr
87
Dukes A survival?
>90% 5 yrs
88
Majority of bacteria in the gut are what?
Obligate anaerobes
89
Coliforms are outnumbered in the gut by anaerobes how much?
by 100 times
90
Leading cause of malnutrition in under 5's?
Diarrhoeal disease
91
E-coli bad strain?
0157
92
Why is cryptosporidium hard to get rid of?
Resistant oocytes (chlorine resistant)
93
Two mechanism by which bacteria cause disease in the gut?
toxins or adherence
94
Bacteria causing enteritis through adherence?
Shigella, e-coli (adherent) campylobcter, salmonellae
95
E-coli produces a toxin what type?
Shiga like toxin
96
E-coli 0157 can cause what complication?
Haemolytic uraemic syndrome (10-15%)
97
Major source of e-coli 0157
cattle
98
Typhoidal salmonella?
Disseminated salmonella
99
Toxin producing gastro organisms abx?
No may cause more toxin release
100
Which bacterium may require abx in gastro?
Campylobacter if long duration + severe or blood culture +ve
101
% of post antibiotic diarrhoea = c diff?
10-25%
102
>99% of pseudomembranous colitis caused by what?
C-diff
103
Which abx can drive 027 strain of c diff?
fluoroquinolones
104
C diff therapy?
metro and vanc
105
New abx for c diff
fidaxomicin
106
Principle of abx therapy?
Start smart then focus!
107
Organisms particularly associated with bowel cancer?
Clostridium septicum and Strep gallolyticus
108
Cholangitis is what?
Infection of common bile duct or biliary tree
109
Pyogenic liver abscess, spread from?
Other intra abdo infect or haematagenous- mesenteric infection or systemic (hep artery)
110
High swinging fever sign of what abdo?
Abscess , fever of 39 then normal then back up etc
111
Subphrenic abscess often has pain where?
Shoulder of side and hiccups
112
Pelvic abscess presentation?
urinary frequent + tenesmus
113
Infected ascites causes?
spontaneous bacterial peritonitis
114
Tb in bowel where?/
Ileo-caecal
115
Liver abscess possible organism?
Strep milleri, poly microbe
116
Treatment for intestinal source under 65 yrs?
Cefuroxime + metro
117
Intestinal source treatment >65years?
Tazocin
118
When to switch IV abx?
After 48hrs apyrexial and normal WCC
