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DIPLOMA 📚 > Gastro-intestinal Disease > Flashcards

Gastro-intestinal Disease Flashcards

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1
Q

Describe the stomach

A
  • J shaped saclike chamber
  • between oesophagus & small intestine
  • fundus - the body - antrum - pyloric sphincter
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2
Q

Define dyspepsia

A

Complex of symptoms of the upper GI tract including discomfort/pain, heartburn, acid reflux, nausea and vomiting

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3
Q

Two categories of dyspepsia

A

Un-investigated

Investigated

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4
Q

Three categories of investigated dyspepsia

A

Peptic ulcer disease
Functional dyspepsia (non ulcer)
GORD

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5
Q

Two subtypes of peptic ulcer disease

A

Gastric ulcers

Duodenal ulcers

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6
Q

Two subtypes of GORD

A

Oesophagitis

Endoscopically negative reflux disease (ENRD)

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7
Q

Is there a link between H.pylori and dyspepsia

A

YAS - but small link

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8
Q

Lifestyle advice for dyspepsia

A 
Lose weight
Stop smoking
Stop alcohol
Reduce coffee, choc, fatty food
Avoid large meals near bedtime 
Raise head of bed through blocks not pillows
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9
Q

Medications causing dyspepsia

A 
NSAIDs
Aspirin
Calcium antagonists
Nitrates
Theophyllines
Bisphosphonates
Corticosteroids
Iron
Antibiotics
Slow release potassium 
Anticholinergics 
SSRIs
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10
Q

Alarm symptoms of dyspepsia

A 
Chronic GI bleeding 
Progressive unintentional weight loss 
Progressive difficulty swallowing 
Persistent vomiting
Iron deficiency anaemia 
Epigastric mass
Suspicion of cancer
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11
Q

Treatment options for dyspepsia

A

Antacids
Alginates
PPI
H2RA

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12
Q

How to antacids work and what are the counselling points

A

Neutralise gastric acid
Liquid more effective but shorter duration as leaves stomach quicker
Take when symptoms are expected between meals and at bedtime
Don’t take with other drugs as impairs absorption and can damage Enteric coating

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13
Q

Some antacids contain a lot of sodium - when should these be avoided

A 
Hypertension
Renal impairment
Heart failure
Lithium therapy
Salt restricted diets
Pregnant women
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14
Q

True or false: calcium containing antacids do not induce rebound acid secretion

A

False- they CAN induce it

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15
Q

True or false: antacids containing magnesium can cause diarrhoea

A

True

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16
Q

True or false: antacids containing aluminium can cause constipation

A

True

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17
Q

How do alginates work and when are they ideal?

A

Form a raft that floats at the surface

Ideal for reflux symptoms

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18
Q

Short term side effects of PPIs

A

GI disturbances (diarrhoea)
Headaches
Dizziness

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19
Q

Long term side effects of PPIs

A

Hypomagnesaemia
Osteoporotic fractures
C.diff
Mask symptoms of gastric cancer

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20
Q

What does the MHRA recommend with PPIs?

A

Ensure adequate vit D and Ca2+ in those at risk of osteoporosis
Measure Mg2+ levels before starting and throughout (especially in those with other Mg2+ lowering drugs such as digoxin, diuretics)

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21
Q

When should PPIs be taken?

A

30-60 mins before breakfast or evening meal

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22
Q

How do PPIs cause interactions?

A

Lower acid in stomach which impairs absorption of some drugs

Can inhibit CYP450

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23
Q

Omeprazole can interact with what

A

Warfarin
Phenytoin
Clopidogrel

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24
Q

Pantoprazole can interact with what

A

Warfarin

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25
Q

Esomeprazole can interact with what

A

Phenytoin

Clopidogrel

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26
Q

Key drugs that should be used with caution or not at all with PPIs

A 
Warfarin
Protease inhibitors
Ulipristal
Clopidogrel
Phenytoin
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27
Q

PPI dosing recommendations

A

Full dose for 1 month or H.pylori test and treat then if symptoms return after successful treatment use PPI low dose then PRN.

If no response try H2RA

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28
Q

Name 4 licensed H2RA

A

Cimetidine
Famotidine
Nizatidine
Ranitidine

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29
Q

Side effects of H2RAs

A 
Diarrhoea
Headache
Dizziness
Rash
Tiredness
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30
Q

How does cimetidine interact with other meds?

A

Bonds to microsomal cytochrome P450 in the liver

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31
Q

Stepping down PPI/H2RA is not appropriate in what scenarios

A

Complicated oesophagitis (past strictures, ulcers, haemorrhage, Barrett’s oesophagus)
People taking a PPI for GI protection against NSAIDs
Previous bleeding peptic ulcer who remain H pylori +ve after at least 2 attempts at eradication

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32
Q

Advice for patients before endoscopy?

A

Do NOT take PPI/H2RAs for a minimum of 2 weeks before endoscopy and don’t take NSAIDs

can use antacids/alginates for symptom relief if needed

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33
Q

NSAID associated GI adverse effects are classified into what three broad categories

A

Nuisance symptoms
Mucosal lesions
Serious GI complications

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34
Q

How do NSAIDs work and cause GI bleeds

A

Inhibit the prostaglandin-generating enzyme (cyclo-oxygenase COX) therefore you have no inhibition of acid secretion

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35
Q

Which type of NSAID are associated with lower GI risk?

A

COX-2 selective such as entoricoxib/celecoxib

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36
Q

NSAIDs with HIGH GI risk

A

Piroxicam
Ketoprofen
Ketorolac

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37
Q

NSAIDs with intermediate GI risk

A

Indometacin
Diclofenac
Naproxen
High dose ibuprofen

38
Q

NSAIDs with lowest GI risk

A

Ibuprofen

39
Q

Which NSAIDs are associated with a small increased risk of thrombotic events (MI & stroke)

A

All NSAIDs including COX2 selective

40
Q

Which NSAIDs are associated with highest CV risk

A

Diclofenac 150mg/ day

Ibuprofen 2.4g/ day

41
Q

Which NSAIDs have lowest CV risk

A

Naproxen (1g/day)

Low dose ibuprofen has not been associated

42
Q

NICE guidance on PUD disease

A

Stop NSAID
full dose PPI for 8 weeks
Treat H.pylori once healed
If still need NSAID review every 6 months, consider alternatives, use COX -2 selective with PPI

43
Q

Risk factors for GORD

A 
Age 45-64
Women
Caucasian 
Lifestyle factors 
Pregnancy (increase progesterone and oestrogen decrease LOS pressure) 
Drugs
44
Q

True or false: h.pylori is protective against GORD

A

True dat

45
Q

Clinical presentation of reflux

A 
Heartburn 
Regurgitation
Waterbrash
Dysphagia
Odynophagia 
Chronic hoarseness/cough
46
Q

What are the aggressive factors for GORD

A

Gastric contents

Duodenal contents

47
Q

What are the defensive factors for GORD

A

Lower oesophageal sphincter
Clearing mechanisms
Tissue resistance

48
Q

What are the complications of GORD

A

Aspiration
Oesophageal stricture
Haemorrhage
Barrett’s oesophagus and adenocarcinoma

49
Q

What is Barrett’s oesophagus

A

The squamous cells of the oesophagus undergo metaplasia to columnar cells which resemble cells of the intestinal mucosa

50
Q

What’s the surgical procedure for GORD

A

Nissen fundoplication

51
Q

Patient has PUD from NSAID use and tests +ve for h. Pylori- what do they need

A

8 weeks full dose PPI as NSAID poses greatest risk THEN eradication therapy

52
Q

How would you describe H.pylori

A 
Spiral
Gram negative
Microserophilic
Rod-shaped bacteria
Multiple flagella
53
Q

What are the virulence determinants of H. Pylori

A

Expression of active forms of a vacuolating cytotoxin

Possession of the cagA (cytotoxin associated gene)

54
Q

Risk factors for peptic ulcer disease

A 
h.pylori 
Use of NSAIDs
Smoking
Alcohol
Lower socio-economic status 
Family history 
Blood group O
Hyperacidity (zollinger-Ellison syndrome)
55
Q

Two common forms/causes of PUD

A

H.pylori associated

NSAID associated

56
Q

Three complications of ulcers

A

Bleeding
Perforation
Obstruction

57
Q

Diagnosis of H.pylori

A

Carbon-13 urea breath test (UBT)
Stool antigen tests
Serological tests

58
Q

Retest to confirm eradication no sooner than *** weeks after completion of treatment using UBT not stool antigen

A

4 weeks

59
Q

Why can you not use serological tests to check eradication of H.pylori

A

Antibody can persist for up to two years after successful eradication

60
Q

Two types of endoscopy to diagnose H.pylori

A

Urease testing

Histology

61
Q

How does urease testing via endoscopy work

A

Urea in the test gel is hydrolysed by urease to produce ammonia (alkaline) brings about a change in pH indicator (phenol red) from yellow to red

62
Q

True or false: false positive urease testing endoscopy results can occur 24 hours after

A

True

63
Q

What bacteria can also produce urease that can cause false positive h.pylori test

A

Proteus spp

64
Q

True or false: healing of GU is not increased by H pylori eradication

A

true - it only benefit healing of DU

65
Q

Eradication of H.pylori treatment

A

Full dose PPI
Amoxicillin +
Clarithromycin/metronidazole

Pen allergic?
Full dose PPI
Clarithromycin
Metronidazole

66
Q

Side effects of PPI

A

Headache

Diarrhoea

67
Q

Side effects of clarithromycin

A

GI upset
Diarrhoea
Altered taste

68
Q

Side effects of amoxicillin

A

GI upset
Headache
Diarrhoea

69
Q

Side effects of metronidazole

A

Metallic tase
Dyspepsia
Alcohol reaction

70
Q

Side effects of tetracyclines

A

GI upset

Photo sensitivity

71
Q

Bismuth containing products can cause what

A

Darkening of the tongue, stool, nausea

GI upset

72
Q

The Rome committee of functional gastrointestinal disorders diagnostic criteria must include one of more of the following

A

Postprandial fullness
Early satiety
Epigastric pain
Epigastric burning

73
Q

Management of h. Pylori negative functional dyspepsia

A

low dose PPI or H2RA for four weeks

74
Q

True or false: SSRIs have been beneficial in functional dyspepsia

A

False - TCAs such as amitriptyline has been

75
Q

Acute diarrhoea is defined as what

A

3 or more watery stools in a day lasting <14 days

76
Q

How long is it classes as persistent diarrhoea

A

> 14 days

77
Q

Causes of travellers diarrhoea

A

Escherichia coli
Salmonella
Cryptosporidium
Giardia

78
Q

What’s dysentry

A

Acute infectious gastroenteritis characterised by loose stools with blood and mucus accompanied by Pyrexia and abdominal cramps

79
Q

Organisms that cause bloody diarrhoea

A 
Campylobacter
Entamoeba histolytica
Escherichia coli
Salmonella 
Shigella
80
Q

Type of gastroenteritis

A 
Acute diarrhoea
Persistent diarrhoea
Travellers diarrhoea
Dysentry
Antibiotic associated diarrhoea
81
Q

Why do adults not normally get rotavirus causing gastroenteritis

A

Commonly before 5yrs - immunity is long lasting

82
Q

Three classes of virus causing gastroenenteritis

A

Rotavirus
Norovirus
Adenovirus

83
Q

5 types of bacteria causing gastroenteritis

A 
Campylobacter
Escherichia coli
Salmonella
Shigella 
Yersinia enterolcolitica (rare)
84
Q

Two types of campylobacter

A

C jejuni

C coli

85
Q

What is shigella

A

Gram negative rod shaped bacterium

86
Q

What is yersinia enterolcolitica

A

Rare gram negative rod shaped bacterium

87
Q

Facts about small intestine

A

Digestion and absorption
6m long with 2.5cm diameter
Three segments: duodenum, jejunum and ileum

88
Q

Large intestine consists of what

A

Colon
Caecum
Appendix
Rectum

89
Q

What does the colon do

A

Extracts water and salt from the chyme received from small intestine

90
Q

Colon can be decided into 3 relatively straight portions

A

Ascending colon
Transverse colon
Descending colon

91
Q

Name the S shaped part of the descending colon

A

Sigmoid colon

92
Q

True or false: numbers and secretion from mast cells are increased in IBS

A

True

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