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4th yr- CMS- Medicine > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What is the GI tract lined with

A

Lines with mucosa from the mouth to the anus

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2
Q

Name some common gastrointestinal problems

A
  1. Inflammatory bowel disease
  2. IBS
  3. Colorectal cancer
  4. Haemorrhoids
  5. Diverticular disease
  6. Enteric infections
  7. Upper GI problems
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3
Q

Give examples of upper GI problems

A
  1. Dysphagia

2. PUD

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4
Q

What is inflammatory bowel disease (IBD)

A

A diverse collection of inflammatory disorders of the gastrointestinal tract

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5
Q

Give examples of soem IBDs

A
  1. Crohns disease

2. ulcerative colitis

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6
Q

Is inflammatory bowel disease fatal

A

Morbidity and mortality can be high

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7
Q

Describe the aetiology of IBD

A
  1. Environmental factors
  2. Genetic predisposition
  3. Host immune response
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8
Q

List some environmental factors for IBD

A
  1. Smoking

2. Depression

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9
Q

List some clinical features of IBD

A
  1. Diarrhoea
  2. Nocturnal symptoms
  3. Weight loss
  4. Fatigue
  5. Nausea/ vomiting
  6. Bloating and abdominal pain
  7. Perianal symptoms
  8. Genital symptoms
  9. Arthritidaes
  10. Skin lesions
  11. Eye disease
  12. Hepatobiliary disease
  13. Vascular disease
  14. Renal disease
  15. Pulmonary disease
    16 Amyloidosis
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10
Q

How can we manage IBD

A
  1. Medical management

2. Surgical management

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11
Q

How can we medically manage IBD

A
  1. Corticosteroids
  2. Aminosalicylates
  3. Immunomodulatory drugs
  4. Biologic agents
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12
Q

How can we surgically manage IBD

A
  1. Resections

2. Stoma formation

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13
Q

What is coeliac disease

A

A gluten specific enteropathy

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14
Q

What oral presentation can patients with coeliac disease have

A
  1. Aphthae
  2. Dermatitis herpetiformis
  3. Angular chelitis
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15
Q

What can patients with coeliac disease have a higher change of developing

A
  1. IBD
  2. CRC
  3. Lymphomas
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16
Q

How do we manage coeliac disease

A

A lifelong gluten free diet is effective curative

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17
Q

How do we diagnose coeliac disease

A
  1. Blood tests to look for antigens that they are reacting to (anti TT)
  2. Upper GI endoscopy
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18
Q

List some risk factors of Colorectal cancer

A

1, Age

  1. Diet
  2. Colorectal polyps
  3. Colorectal cancer
  4. Tobacco
  5. Acromegaly
  6. abdominal radiotherapy
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19
Q

Give some clinical features of Colorectal cancer

A
  1. Altered bowel habit
  2. PR bleeding, tenesmus
  3. Symptomatic anaemia
  4. Rectal/ abdo mass
  5. Asymptomatic
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20
Q

How can we manage Colorectal cancer

A
  1. Tumour resection
  2. Possible stoma formation
  3. Adjuvant chemotherapy
  4. Radiotherapy not useful for bowel lesions
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21
Q

What does the prognosis of Colorectal cancer depend on

A

Depends on cancer stage and presence of metastasis

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22
Q

What is the common name of Colorectal cancer

A

Bowel cancer

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23
Q

How common is Colorectal cancer

A

4th most common caner

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24
Q

Is Colorectal cancer fatal

A

2nd biggest killer in the uk

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25
Q

At what age do you get sent a at home blood test for bowel cancer

A

60

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26
Q

What does the treatment of colorectal cancer depend on

A

Site of caner Dietary triggers

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27
Q

What are the benifets of adjuvant chemotherapy

A

improved disease free survival and overall survival in stage 3 cancer

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28
Q

When is radiotherapy not a useful treatment for colorectal cancer

A

When the cancer is proemial to the rectum

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29
Q

Why is radiotherapy not a suitable treatment for colorectal cancer when it is proximal to the rectum

A

As it would be difficult to administer a high enough dose without famafign adjacent structures eg small bowel

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30
Q

What are soem of the risks when removing colorectal cancer

A
  1. Bleeding
  2. Infection
  3. Blood clots
  4. Damage to nearby organs
  5. Leaking joints
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31
Q

What are some safe effects of rectal cancer surgery

A

Sexual dysfunction
Erectile dysfunction
Bladder function changes

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32
Q

What are stomas

A

Small pouches that can be connected to your digestive tract to help taste to be diverted out of the body

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33
Q

what are the disadvantages of stomas

A

1They may lead to feelings of shame or prevent intimate relationships, swimming etc

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34
Q

Name the most common GI presentation

A

Irritable bowel syndrome

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35
Q

What triggers irritable bowel syndrome

A

Dietary triggers

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36
Q

How much does IBS cost the NHS

A

£45.6 MILLION per year

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37
Q

List some associations of IBS

A
  1. Fibromyalgia
  2. Menstrual dysfunction
  3. Joint hyper mobility
  4. Anxiety
  5. Trauma
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38
Q

How can IBS affect a persons life

A

25% of patents with IBS take 7-13 days off work

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39
Q

How do we diagnose IBS

A

By symptom reading no physical exam

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40
Q

What requirement must be filled before we can diagnose a patient with IBS

A

In preceding 3 months they must have at least 3days/ mont of recurrent abdominal pain or discomforted associated with:

  1. Improvement with dedication
  2. Onset with change in frequency of stool
  3. Onset with a change in the appearance of stool
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41
Q

What do we need to rule out before diagnosing a patient with IBS

A

§. IBD

  1. CRC
  2. Enteric infection
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42
Q

How do we treat IBS

A

Explain the symptoms to the patient
No further treatment usually required just support and reassurance
Try to avoid dietary triggers and maintain high fibre diet

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43
Q

What can we prescribe patents with diarrhoea associated with IBS

A

loperamide

44
Q

What can we prescribe patents with CONSTIPATION associated with IBS

A

Laxitives and high fibre diet

45
Q

What is dIverticular disease

A

The existence of out pouching along the intestines

46
Q

What is diverticulitis

A

An acute infection of one or more pouches on the intestine

47
Q

Is diverticular disease and diverticulitis the same

48
Q

What can cause diverticular disease

A

Chronic constipation due to poor dietary fibre intake which can lead to weaken of the bowel wall with out pouching developing

49
Q

Why is out pouching of the intestines danger

A

As fecal matter can collect their prevention the removal of it from eh bowel

50
Q

Other than chronic constipation why else can diverticular disease occur

A

Due to cholinergic denervation with age leads to hypersensitivity and less coordinated muscle contractions.

51
Q

Where and in whom is diverticula usually found

A

Diverticula frequently found in the colon and occur in 50% of people >50yrs

52
Q

What can diverticular disease be confused with

53
Q

When do we usually diagnose diverticular disease

A

During a bowel endoscopy for a operate issue

54
Q

Why is diverticular disease sometimes not diagnosed

A

As can be asymptomatic

55
Q

What advise can we give patents to reduce the likelihood of developing diverticular disease

A

Implement a high fibre diet

56
Q

What are soem complication of diverticular disease

A
  1. Bowel perforation
  2. Abscess Formation
  3. Fistulae into adjacent organs
  4. haemorrhage
  5. peritonitis (potentially life threatening)
57
Q

How are haemorrhoids classify

A
  1. Primary
  2. Second degree
  3. Third degree
58
Q

Describe a primary haemorrhoids

59
Q

Describe a second degree haemorrhoids

A

Prolapsing

60
Q

Describe a third degree haemorrhoids

61
Q

What can haemorrhoids cause

A

Rectal bleeding

62
Q

How can we mange haemorrhoids with minor symptoms

A

No treatment usually only advise on how to avoid constipation

63
Q

How can we mange haemorrhoids with severe symptoms

A

Rubber band ligation or injection of sclerosant this is to shirivel the
haemorrhoids

64
Q

Name a common enteric infection

A

Acute gastroenteritis

65
Q

What can Acute gastroenteritis cause

A

Diarrhoea with or without vomiting

66
Q

How can we help mange someone who is suffering from diarrhoea and vomitign

A

Giving oral rehydration solution

67
Q

how many people die form diarrhoeal disease?

A

2 million per year

68
Q

What can cause Acute gastroenteritis

A
  1. Viral cause
  2. Protozoal and helminthic infection
  3. Bacterial cause
69
Q

Which virus is most commonly known to cause Acute gastroenteritis

70
Q

Name the most common cause of Acute gastroenteritis in adults

A

Bacterial infection by Clostridium difficile

71
Q

What is Clostridium difficile also known as

A

pseudomembranous colitis

72
Q

What might cause Clostridium difficile induced Acute gastroenteritis

A

Prolonger or inappropriate antibiotic use

73
Q

How can we prevent bacteria induced Acute gastroenteritis

A
  1. Responsible use of antibiotics
  2. Have good Hand hygiene
  3. Regular clean surveys in hospitals to reduce transmission
  4. Isolation of patient with Clostridium difficile
74
Q

How do we mange enteric infection

A

Oral rehydration solution

NO antibiotics required

75
Q

Name the most common pathogens that can cause food poisoning

A
  1. Campylobacter,
  2. Cryptosporidium,
  3. Salmonella,
  4. Shiga toxin-producing E-Coli,
  5. Shigella
76
Q

How can we reduce the cases of food poisoning

A
  1. Proper hand hygiene and surface cleaning
  2. Separating risky foods
  3. Storing food at a safe temperature
  4. Ensuring food is cooked at a high enough temp
77
Q

What does dysphagia mean

A

Difficulty swallowing

78
Q

What does odynophagia mean

A

Painful swallowing

79
Q

Why might a patient have dysphagia

A
  1. Post stoke leading to weak tongue
  2. Parkinsons disease
  3. Cranial nerve palsy
80
Q

What is a red flag for a patient with dysphagia

A

A persistent or progressive sensation of a lump in the throat or inability to swallow solids accompanied by weight loss

81
Q

What is high dysphagia

A

Difficulty in swelling caused by problems with the mouth or throat

82
Q

What can odynophagia be caused by

A
  1. oesophageal inflammation (oesophagitis) due to gastro-oesophageal reflux disease (GORD)
  2. infections of the
    oesophagus
  3. drugs
83
Q

How do we investigate dysphagia

A
  1. Oesophagogastroduodenoscopy (OGD)
    2, Contrast studies
  2. MRI of small bowel
  3. Oesophageal Manometry
84
Q

What is a Oesophagogastroduodenoscopy (OGD)

A

When a flexible endoscope is navigated through the mouth into the oesophagus, stomach and duodenum

85
Q

How do we perform contrast studies to investigate dysphagia

A

Patient can ingest barium and get a radiograph of the oesophagus, stomach and duodenum and small intestine to see how far the barium gets

86
Q

When do we carry out a Oesophageal Manometry

A

Used to investigate suspected mortality disorders

87
Q

how do we carry out a Oesophageal Manometry

A

A small tube which contains pressure inducers is passed through the nose and into the oesophagus
Pressure and peristalsis is assed when patient swallow

88
Q

What does PUD stand for

A

Peptic ulcer disease

89
Q

What causes peptic ulcer disease

A

A peptic ulcer

90
Q

What is a peptic ulcer

A

A mucosal ulcer un or adjacent to an acid bearing area

91
Q

Where do peptic ulcers form

A

Stomach and proximal duodenum

92
Q

How common are duodenum ulcers

A

15% of the population at any given time have a duodenum ulcer

93
Q

What is the most common cause of peptic ulcers

A

H pylori and NSAIDS/ aspirin

94
Q

Why does taking an excess of NSAID/ Aspirin cause ulcers

A

Due to reduced production of prostaglandins which provide mucosal protection in the upper GIT.

95
Q

What is the most common symptom fo peptic ulcer dais

A

Burinng epigastric pain

96
Q

How is Burinng epigastric pain relieved

A

By antacids and a variable response to food

97
Q

When to duodenal ulcers cause pain

A

Usually when the patient is hungry or classically at night

98
Q

List soem other symptoms of peptic and duodenal ulcers

A
  1. Heartburn
  2. Nausea
  3. flatulence
  4. Perforation or painless haemorrhage
99
Q

What symptoms to patients with severe ulcerations usually present with

A

Usually asymptomatic

100
Q

What can happen to the symptoms of duodenal ulcers if they go untreated

A

They can relapse and remit spontaneously if they go untreated

101
Q

List soem complications of peptic ulcer disease

A
  1. Haemorrhage
  2. Perforation
  3. Gastric outlet obstruction
102
Q

What signs a symptoms would a patient with a haemorrhage due to peptic ulcers come with

A
  1. Acute upper GI bleeds
  2. Vomiting of blood
  3. Passing of malaria (black tarry stool)
103
Q

`Which type of ulcer is most likely to perforate

A

Duodenal ulcers

104
Q

How do we manage the perforation of an ulcer

A
  1. Laparoscopic surgery to close the perforation and drain abdomen
  2. Conservative management using nasogastric suction
105
Q

Wby does gastric outlet obstruct occur

A

Occurs due to oedema surround gin an active ulcer or due to scarring which occurs following ulcer healing

4th yr- CMS- Medicine (14 decks)

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