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3a > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What are the risk factors for developing GORD?

A 
Alcohol
Pregnancy
Hiatus hernia
Obesity
Smoking
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2
Q

In GORD, the lower oesophageal sphincter tone is reduced. This leads to more frequent lower oesophageal relaxations and reduces oesophageal clearance of acid. What are the complications of GORD?

A 
Oesophagitis
Ulcers
Benign stricture
Iron deficiency
Barrett's oesophagus
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3
Q

In Barrett’s oesophagus, the distal epithelium undergoes metaplasia. Which epitheliums are involved here?

A

Squamous —> Columnar

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4
Q

What are the oesophageal symptoms of GORD?

A 
Heartburn
Belching 
Acid or bile regurgitation
Increased salivation
Odynophagia = painful swallowing
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5
Q

What are the extra- oesophageal symptoms of GORD?

A

Nocturnal asthma
Chronic cough
Laryngitis - hoarse voice
Sinusitis

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6
Q

Which investigations can you do to diagnose GORD?

A

Endoscopy
Barium swallow
24 hour oesophageal PH monitoring

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7
Q

Which lifestyle changes can you advise for someone with GORD?

A 
Weight loss
Reduce alcohol, hot drinks, spicy foods, fizzy drinks
Avoid eating <3 hours before bed
Stop smoking 
Small regular meals
Raise bed head
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8
Q

Which drugs can you give to treat GORD?

A

Antacids
PPIs e.g. lansoprazole
H2 receptor antagonist e.g. ranitidine

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9
Q

Surgery is indicated in severe GORD. What type of surgery is this?

A

Laparoscopic - increases lower oesophageal sphincter pressure

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10
Q

How do PPIs work?

A

Inhibits gastric H+/K+ ATPase, blocking luminal secretion of gastric acid

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11
Q

What is IBS?

A

Mixed group of abdominal symptoms for which no organic cause can be found

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12
Q

What are the risk factors for IBS?

A 
Smoking 
Excessive alcohol
Young age 
Female sex
Psychological stress
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13
Q

What are the symptoms of IBS?

A 
Chronic pattern, exacerbated by stress 
Abdominal pain relieved by defecation
Urgency
Diarrhoea/ constipation
Incomplete evacuation
Worsening of symptoms after food
Mucus in rectum
Bloating
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14
Q

Which investigations would you do if you suspected IBS?

A 
Routine bloods
Coeliac screen
Serum CA-125 to exclude ovarian cancer
Faecal calprotectin - marker of bowel inflammation which is raised in IBS
Colonoscopy if >50 years
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15
Q

Outline the management of IBS.

A 
Avoid trigger foods
Ensure adequate water and fibre intake
Laxatives
Bulking agent + loperamide for loose stool
Antispasmodic e.g. mebervine
Probiotics
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16
Q

UC is a chronic relapsing and remitting inflammatory disorder of the colonic mucosa. Define proctitis, left-sided colitis and pancolitis.

A

Proctitis = Just rectum
Left-sided colitis = Rectum, sigmoid colon, descending colon
Pancolitis = Extends to entire colon

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17
Q

Does smoking increase or decrease risk of UC?

A

Decreases.

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18
Q

State 5 key pathological features of UC.

A
  1. Only effects mucosa
  2. Only effects colon - rectum to caecum
  3. Continuous - no skip lesions
  4. Red and bloody mucosa
  5. Ulcers and pseudopolyps can develop
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19
Q

What are the symptoms of UC?

A 
Diarrhoea
Blood and mucus in stool
Crampy abdominal pain
Urgency
Tenesmus 
Fever
Malaise 
Fatigue 
Weight loss
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20
Q

What are the signs of UC?

A 
Tachycardia
Tender, distended abdomen
Clubbing
Pallor
Blood on DRE
Uveitis
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21
Q

Which investigations can you do to diagnose UC?

A 
Routine bloods
Stool culture to exclude infection
Faecal calprotectin - significantly raised in UC 
Abdominal X-ray
Lower GI endoscopy - gold standard
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22
Q

What are the signs of UC on an abdominal x-ray?

A

Mucosal thickening
Colonic dilatation
No faecal shadows

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23
Q

What are the complications of UC?

A 
Colorectal cancer
Bowel perforation 
Severe bleeding 
Toxic megacolon
Malnutrition
Arthritis
Ankolysing spondylitis 
Gallstones
Anaemia
Osteoporosis
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24
Q

How would you treat mild and moderate UC?

A

5-ASA e.g. sulfasalazine

Steroids

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25
Q

How would you treat severe UC?

A

Nil by mouth
IV hydrocortisone
Rectal steroids
Immunosuppression e.g. Infliximab, anti-TNFa

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26
Q

What surgery can you do in UC patients with no improvement?

A

Colectomy

Terminal ileostomy

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27
Q

What are the risk factors for developing UC?

A 
FH 
HLA-B27 positive
Recent GI infection
NSAID use
Smoking cessation 
Ashkenazi Jewish descent
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28
Q

Crohn’s disease is a chronic inflammatory disease of the bowel. What are the risk factors for developing Crohn’s?

A

FH
Smoking
Stress
Depression

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29
Q

State 5 key pathological features of Crohn’s disease.

A
  1. Affects entire GI tract from mouth to anus
  2. Skip lesions
  3. Cobble stone mucosa
  4. Transmural inflammation -= all layers of bowel wall are effected
  5. Granulomas
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30
Q

What are the symptoms of Crohn’s?

A 
Fatigue
Diarrhoea
Constipation
Rectal bleeding 
Incomplete evacuation
Urgency
Abdominal pain
Weight loss
Malaise
Night sweats
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31
Q

What are the signs of Crohn’s?

A 
Abdominal tenderness/mass
Perianal abscess/fistulae
Skin tags 
Clubbing 
Mouth ulcers
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32
Q

What are the complications of Crohn’s?

A 
Bowel perforation
Fistulae
Fissures
Strictures
Abscess 
Rectal haemorrhage 
Colon cancer
Primary sclerosing cholangitis 
Small bowel obstruction
33
Q

Which investigations can you do to diagnose Crohn’s?

A

Routine bloods
Stool culture to exclude infection
Colonoscopy with rectal biopsy
MRI of small bowel

34
Q

How would you treat mild Crohn’s?

A

Oral prednisolone

35
Q

How would you treat severe Crohn’s?

A

IV hydrocortisone
Blood transfusion
Immunosuppressants
TNFa inhibitors

36
Q

What surgery can be done in Crohn’s?

A

Bowel resection

37
Q

What are the risk factors for developing bowel cancer?

A 
IBD
FH
Diet high in red meat, low in fibre
Excess alcohol
Smoking 
Neoplastic polyps
38
Q

Name 5 places in the GI tract where bowel cancer can develop

A 
Rectum
Sigmoid colon
Ascending colon
Caecum 
Appendix
39
Q

What are the symptoms of bowel cancer?

A 
Weight loss
Fatigue
Night sweats
Blood in stools
Mucus in stools
Tenesmus 
Persistent unexplained change in bowel habit Abdominal pain
40
Q

What are the signs of bowel cancer?

A

PR mass
Abdominal mass
Fistula

41
Q

Outline 4 urgent referral criteria for someone presenting with bowel cancer.

A
  1. Anyone >40 with PR bleeding + bowel habit change
  2. Any age with right lower abdominal mass
  3. Palpable rectal mass
  4. Men or non-menstruating women with unexplained iron deficiency anaemia
42
Q

What investigations can you do to diagnose bowel cancer?

A 
FBC: microcytic anaemia
Faecal occult blood - screening 
CE antigen levels 
Colonoscopy - gold standard
CT/MRI to assess mets
43
Q

Bowel cancer can be staged by TNM staging. Outline the Duke’s criteria which classifies severity of bowel cancer.

A

A: Limited to muscularis mucosae, 95% 5 year survival
B: Extension through muscularis mucosae, 77% 5 year survival
C: Regional lymph nodes, 48% 5 year survival
D: Distant mets, 6.6% 5 year survival

44
Q

What treatment options are available for bowel cancer?

A

Surgery: resection, colectomy etc
Radiotherapy
Chemotherapy

45
Q

What is a diverticulum, which occurs in diverticular disease?

A

Outpouching of gut wall, usually at site of perforating arteries

46
Q

What is diverticulitis?

A

Inflammation or infection of diverticula. Occurs when faeces obstruct neck of diverticulum.

47
Q

Diverticular disease is where increased pressure in the bowel lumen, causes the mucosa to herniate into muscle. The faeces can then sit in the diverticulum and inflame, leading to rupture and peritonitis. What is a risk factor for this?

A

Low fibre diet as colon has to push harder

48
Q

Which part of the colon does diverticular disease mainly occur?

A

Sigmoid colon

49
Q

What are the symptoms of diverticular disease?

A

Asymptomatic
Abdominal pain
Constipation
PR bleeding

Diverticulitis:
Fever, nausea, LIF pain

50
Q

What investigations can be done to diagnose diverticular disease?

A

Routine bloods: raised WCC, ESR
Colonoscopy
CT
Abdominal x-ray - shows free air, indicating perforation

51
Q

What are the signs diverticulitis?

A 
Tender abdomen
Abdominal pain
Ascites
Involuntary guarding - tensing of abdominal muscles
Rigid abdomen
Reduced or absent bowel sounds 
Tachycardia
Hypotension
52
Q

What are the complications of diverticular disease?

A 
Ileus
Perforation
Peritonitis 
Mortality
Haemorrhage
Fistulae
Abscess 
Post infective stricture
53
Q

How would you manage diverticular disease?

A

High fibre diet

Antispasmodics

54
Q

How would you manage diverticulitis?

A 
CT guided percutaneous drainage 
Analgesia
Nil by mouth
IV fluids
Antibiotics
55
Q

A peptic ulcer is an ulcer of the mucosa adjacent to an acid-bearing area - therefore they can occur in the stomach or duodenum. What are the causes of peptic ulcers?

A 
H.pylori infection
NSAIDs
Hyperparathyroidism
Sarcoidosis
Crohn's disease
56
Q

How do NSAIDs cause peptic ulcers?

A

NSAIDs block prostaglandin synthesis by inhibiting COX-1. These prostaglandins are needed to provide mucosal protection, so without them, the stomach is irritated.

57
Q

Which drug, which when taken with NSAIDs, increases risk of peptic ulcer formation?

A

Corticosteroids

58
Q

What are the symptoms of peptic ulcer disease?

A

Bloating
Heartburn
Tender epigastrium

59
Q

What are the signs of peptic ulcer disease?

A 
ALARMS
Anaemia
Loss of weight
Anorexia 
Recent onset
Melaena 
Swallowing difficulty
60
Q

Which investigations would you do for a patient who is <55 or has no ALARM symptoms?

A

Non-invasive h.pylori test:

  1. 13C-urea breath test
  2. Stool antigen test
61
Q

Which investigations would you do for a patient who is >55 or has ALARM symptoms?

A

Endoscopy with biopsy

62
Q

How would you treat +ve H.pylori peptic ulcer?

A

PPI + 2 antibiotics

Eradication confirmed with breath test/stool sample

63
Q

How would you treat -ve H.pylori peptic ulcer?

A

Stop NSAIDs

PPI

64
Q

What are the complications of peptic ulcers?

A

Bleeding
Perforation
Malignancy
Gastric outflow obstruction

65
Q

In appendicitis, gut organisms invade the appendix wall after lumen obstruction. What causes appendicitis?

A

Faceolith (hardened stool)
IBD
Filarial worms
Infection

66
Q

What are the symptoms of appendicitis?

A 
Epigastric pain that moves to RIF
Pain worse on movement, coughing and sneezing 
Sudden onset pain
Loss of appetite
Nausea + vomiting 
Fever 
Abdominal swelling
67
Q

What are the signs of appendicitis?

A 
Tachycardia
Fever
Furred tongue
Shallow breaths
Guarding 
Rebound + percussion tenderness of RIF
Psoas sign = pain on extending hip
Rovsing's sign = Pain greater in RIF than LIF, when LIF is pressed
68
Q

What investigations can you do to diagnose appendicitis?

A

Bloods: raised CRP and neutrophil leucocytosis

CT - gold standard

69
Q

What are the complications of appendicitis?

A

Perforation

Abscess

70
Q

How would you manage appendicitis?

A

Appendicectomy

IV antibiotics

71
Q

What are the causes of constipation?

A 
Dehydration
Autonomic neuropathy
Opiates
Iron supplements
Ondansetron
72
Q

What are the complications of constipation?

A

Haemorrhoids
Faecal impaction (stools collect in rectum) - leads to overflow diarrhoea
Bowel incontinence

73
Q

What lifestyle advice can you give to someone with constipation?

A

Increase daily intake of fibre
Drink more water
Daily exercise
Keep to a routine when going to the toilet

74
Q

Name the 3 types of laxative given in constipation

A
  1. Bulk forming - help stools retain fluid
  2. Osmotic - increase fluid in bowel
  3. Stimulant - stimulates muscles in bowel to move stools
75
Q

Name an osmotic laxative

A

Lactulose

Macrogols

76
Q

Name a stimulant laxative

A

Senna

Bisacodyl

77
Q

Name a bulk forming laxative

A

Isphaghula husk

78
Q

How would you treat faecal impaction?

A

High dose macrogol with senna
Bisacodyl suppository
Enema of docusate

3a (13 decks)

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