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IPE > Gastroenrology > Flashcards

Gastroenrology Flashcards

1
Q

Non GI symptoms of IBS

A 
Dysmenorrhoea
Dysparaunia
Increased urinary frequency and urge
Back pains
Headaches
Poor sleeping 
Fatigue
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2
Q

Triggers for ibs

A 
Anxiety 
Depression
Stress
GI infection
Antibiotics
Abuse 
Eating disorders
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3
Q

Associated disorders with ibs

A

TMJ dysfunction
ME
Fibromyalgia

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4
Q

Treatments of IBS constipation

A

Ispaghula husk

High fibre diet

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5
Q

Treatment of IBS diarrheoa

A

Loperamide

Codein

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6
Q

Treatment of IBS cramps

A

Mebevarine

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7
Q

Treatment of IBS mental state

A

Antidepressants

Psychiatrist

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8
Q

General treatment of IBS. What does it do?

A

Linaclotide - increases motility aiding consitpation and decreases bowel sensation

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9
Q

Diagnostic criteria for ibs

A

In last 3 months
At least 3 days a month of abdo pain/discomfort
With at least 2 of improves with deification, associated with change in stool frequency, associated with change in stool form
And no organic cause suspected

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10
Q

Extra gastroentestinal symptoms with inflammatory bowel disease

A 
Arthritis or arthralgia 
Ankalosing spodylitis
Clubbing
Uveitis
Erythema nodosum
Pyoderma gangrenosum 
Sclerosing cholangitis  
Liver problems fatty to cirrhosis
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11
Q

Complications of inflammatory bowel disease

A

Anaemia
Bowel cancer
Decreased fertility and miscarriage
Toxic megacolon

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12
Q

General symptoms of inflammatory bowel disease (both types)

A 
Diarrhoea day and night
Abdominal pains
Weight loss
Anorexia
Lethargy 
Nausea and vomiting
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13
Q

In which ibd is smoking protective?

A

Ulcerative colitis

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14
Q

Risk factors for ibd

A 
Family history 
Jewish ethnicity 
Caucasian 
Upbringing - hygiene hypothesis 
Lack of breast feeding
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15
Q

What is a big risk factor in ibd for bowel cancer? What screening should be done?

A

Primary sclerosing cholangitis
Normal - colonoscopy every 2 yrs after 10 then yearly after 20
With AC - yearly colonoscopy

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16
Q

What immunological tests can be used in ibd?

What do they mean?

A

Faecal calprotectin - component of neutrophils thus if raised in faeces inflammation of bowel wall.
ANCA - antibodies against neutrophil proteins

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17
Q

Which ibd is more common in females?

A

Crohns

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18
Q

Which ibd is most common?

A

Uc

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19
Q

What are the clinical features that suggest crohns disease over uc?

A

Smelly faeces
Perianal disease
Internal fistulas with faceces appearing where it shouldn’t
Colicky pain

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20
Q

What condition may an acute presentation of crohns disease mimic

A

Appendicitis

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21
Q

What colonoscopic features would suggest crohns over uc?

A

Cobblestoning
Fistulas and abscesses
Aphthoid ulceration

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22
Q

What histological changes suggest crohns over uc?

A

Transmurial inflammation

Granulomas

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23
Q

What radiological features suggest crohns over uc?

A

Asymmetrical pattern
Stricturing
Skip lesions
String sign of cantor

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24
Q

What test would be needed to elicit string sign of cantor?

A

Barium swallow

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25
Q

What are treatment options for crohns disease exacerbations?

A

Mild attack - prendisolone

Severe attack - hydrocortisone, metronidazole, infliximab

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26
Q

Long term treatment options for crohns disease?

A 
Azothioprine
Sulfasalazine
Infliximab
Methotrexate
Surgery
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27
Q

How can severity of uc be graded?

What else suggest severity?

A

severe - >6 per day with blood +++

Fever, tachycardia, anaemia, hypoalbuminia, high esr

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28
Q

In what gender is uc more common?

A

Males

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29
Q

What specific symptoms may uc patients complain of?

A

Blood and mucus in diarrhoea

Urgency or tenesmus

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30
Q

Which is more painful, crohns or uc?

A

Crohns

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31
Q

What would be seen on colonoscopy that would be suspicious of uc?

A

General inflammation and ulceration

Mucosal islands

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32
Q

What biopsy changes would suggest uc over crohns?

A

Superficial inflammation
Crypt abscesses
Inflammatory cells
Lack of goblet cells

33
Q

Specific radiological signs of uc over crohns?

A

Thumb printing - thickening of mucosa on haustra
Loss of haustra - lead pipe sign
Collar button ulcers

34
Q

Treatment to induce remission in uc?

A

Prednisolone

Ciclosporin

35
Q

Drugs to maintain remission in uc?

A

Mesalazine

Azothioprine

36
Q

How would mesalazine be give in UC ?

A

Suppository or modified release

37
Q

What drugs would be considered in UC not directly related to immune modulation?

A 
Heparin as high clotting risk!
Bisphosphonate if on steroids
Antibiotic cover if on immunosuppressants
Laxitives if constipated
Probiotics if pouchitis
38
Q

What surgical options exist for ulcerative colitis?

A

Proctocolectomy with terminal ileostomy

Colectomy with ileo-anal pouch

39
Q

When do most cases of crohns develop?

A

16-30

And 60-80

40
Q

What age does UC most commonly develop?

A

15-25

41
Q

What signs would present in a crohns disease patient with fistulas?

A

Pneumatouria

Faecouria

42
Q

How does pyoderma gangrinosum present?

A

Rapid onset rapidly enlarging ulcer often with a purple edge

43
Q

How should pyoderma gangrinosum be treated?

A

Remove necrotic tissue but NO wide excision
Swab and abx if +ve
Steroids
If severe immunosuppression

44
Q

What are the stages of proximal progression of uc?

A 
Proctitis
Proctosigmoiditis
Left sided
Extensive
Pancolitis 
Backwash ilitis
45
Q

Other forms of ibd than uc and cd

A

Microscopic ulcerative colitis
Microscopic lymphocytic colitis
Microscopic collagenous colitis

46
Q

What environmental factors may play a role in ibd?

A

Hygiene hypothesis
Breast feeding
Nutrition
Smoking (CD - exacerbates, UC protective)
Appendectomy (UC - protective, CD - exacerbates)
Intestinal microflora - immune response against?

47
Q

Where is particularly influenced by crohns?

A

Terminal ilium

Ascending colon

48
Q

Which of uc or cd increases gallstone risk?

A

CD

49
Q

Differentials of IBD?

A

Lymphoma
Infection
Carcinoma

50
Q

What sorts of anaemia appear in IBD?

A

Microcytic iron deficiency
Normocytic of chronic disease
Megaloblastic due to terminal ilial disease

51
Q

Tests to run on a ?IBD patient?

A

Bloods - FBC (anaemia, infection), CRP (inflammation), liver biochemistry (liver involvement), ANCA
Stool cultures
Abdo xray
Barium follow through or oral contrast CT
Colonoscopy

52
Q

When should colonoscopy be performed in suspected UC?

A

After acute episode due to risk of perforation during

53
Q

What are disease activity markers in CD?

A

Hb
Albumin
Inflammatory markers

54
Q

Normal sizes for small, large and cecum on AXR?

A

3,6 and 9 cm

55
Q

Signs of toxic megacolon on axr

A

Colon >6cm
Thin walled
Gas filled
Mucosal islands

56
Q

How could lone proctitis be treated in UC?

A

Rectal steroids

57
Q

What would trigger surgery in a chronic presentation of UC?

A

Incomplete response to meds
Excessive steroid use
None compliance
Cancer risk

58
Q

Acute indications for surgery in UC?

A

Toxic megacolon
Failure of treatment
Haemorrhage
Perforation

59
Q

What are the presentations of the microscopic colitis’s?

A

Watery diarrhoea

Macroscopically normal

60
Q

Prevalence of diverticular disease?

A

> 50% of over 50s with 95% being asymptomatic

61
Q

Presentation of chronic diverticular disease?

A

Left iliac fossa pain, erratic bowel habits, constipation

62
Q

Diagnosis of chronic diverticular disease?

A

Colonoscopy

63
Q

Treatment of chronic diverticular disease

A

High fibre diet

Smooth muscle relaxants

64
Q

Symptoms of acute diverticulits

A

Severe left iliac fossa pain
Bowel disturbance
Fever

65
Q

Signs of acute diverticulitis

A

Tenderness guarding and rigidity

Sometimes palpable mass

66
Q

Diagnosis of acute diverticulitis?

A

Ct showing colonic wall thickening, diverticula and abscesses

Do not do colonoscopy!

67
Q

Bloods in acute diverticulitis?

A

Raised esr and crp

Leucocytosis

68
Q

Treatment of acute diverticulitis

A

Cephalosporin and metronidazole

Iv fluids

69
Q

Complications of acute diverticulitis

A

Perforation - peritonitis, fistula
Obstruction
Bleeding

70
Q

Causes of upper gi bleeding

A 
Peptic ulcer
Mallory weiss tear
Oesophageal varices
Nsaids/steroids/anticoagulants/thrombolytics
Oesophagitis
Gastric erosions
Malignancy
71
Q

What can cause gastritis?

A

Alcohol, nsaids, hpylori, atrophic gastritis, granulomas (chrones, sarcoidosis), reflux

72
Q

Presentation of gastritis?

A

Epigastric pain, vomiting, haematemesis

73
Q

Diagnosis of gastritis?

A

Endoscopy and biopsy

74
Q

Treatment of gastritis

A

Ppi or ranitidine,

Hpylori eradication

75
Q

What score can be used to predict mortality in upper gi bleeding? Components?

A

Rockall score
Age
SBP and pulse
Comorbidites

76
Q

Acute management of a upper gi bleed?

A 
Airway
High flow O2 
Cannulate with resuscitation fluids 
Bloods - fbc, u+e, lft, clotting, crossmatch 
Catheter and monitor 
Cxr, abg, ecg
Omeprazole bolus and ivi 
Urgent endoscopy
Inform surgeons  
Keep nil by mouth
77
Q

What may show on U+Es in a GI bleed?

A

Increased urea from digested blood

78
Q

What does an itch tell you about jaundice?

A

That it is a conjugated hyperbilirubinaemia not unconjugated. Unconjugated does not itch.

79
Q 
What would be found in the urine in:
Conjugated
Unconjugated
Bilirubinaemia
And heamolytic anaemia
A

Conjugated - bilirubin
Unconjugated - urobiliogen
Hamolytic - haemoglobin

IPE (17 decks)

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