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Gastroenterology Flashcards

1
Q

Coeliac disease

A

autoimmune condition where exposure to gluten causes an autoimmune reaction that causes inflammation in the small bowel

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2
Q

Coeliac disease epidemiology

A

F>M 2:1
Presentation is bimodal (in infancy and at age 50-60)
more common in Irish populations.

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3
Q

Coeliac disease pathophysiology

A

auto-antibodies are created in response to exposure to gluten that target the epithelial cells of the intestine and lead to inflammation which affects the small bowel, particularly the jejunum.
It causes atrophy of the intestinal villi.
The inflammation causes malabsorption of nutrients and the symptoms of the disease.

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4
Q

Risk factors for coeliac disease

A

Female
Family history
IgA deficiency
Autoimmune disorder history

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5
Q

Coeliac disease clinical presentation

A

Failure to thrive in young children
Diarrhoea
steatorrhea
Fatigue
Weight loss- sudden/unexpected
Mouth ulcers
Abdo pain
distension
Anaemia
Dermatitis herpetiformis

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6
Q

Dermatitis herpetiformis

A

an itchy blistering skin rash typically on the abdomen,pruritic papulovesicular lesions over the buttocks and extensor surfaces of the arms, legs, knees, and trunk

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7
Q

Coeliac disease Ix

A

Stool culture- to exclude infection.
Total immunoglobulin A
Disease-specific antibodies
- Raised anti-TTG IgA, raised anti endomysial antibodies
Endoscopy and duodenal biopsy

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8
Q

Coeliac disease histology on biopsy

A

Immune destruction of small bowel villi leads to diagnostic biopsy findings of:

Villous atrophy (as enterocytes forming the tips of villi are destroyed)
Crypt hyperplasia (basal cells rapidly divide to try to compensate for distal villi cell destruction)
Increased epithelial lymphocytes
Lamina propria infiltration with lymphocytes

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9
Q

Blood tests in coeliac disease

A

FBC
U&E and bone profile (vitamin D absorption may be impaired)
LFT (albumin may be low secondary to malabsorption)
Iron, B12, Folate

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10
Q

Coeliac disease is associated with

A

Type 1 Diabetes
Thyroid disease
Autoimmune hepatitis
Primary biliary cirrhosis/cholangitis
Primary sclerosing cholangitis
Dermatitis herpetiformis

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11
Q

Coeliac disease Mx

A

Lifelong gluten-free diet
Education/monitoring for adherence
Pneumococcal vaccine due to hyposplenism with booster every 5 years
NICE CKS guidelines recommend annual blood tests for FBC, ferritin, thyroid function tests, liver function tests, B12 and folate

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12
Q

Coeliac disease Cx

A

Vitamin deficiency
Anaemia
Osteoporosis
Ulcerative jejunitis
Enteropathy-associated T-cell lymphoma (EATL) of the intestine
Non-Hodgkin lymphoma (NHL)
Small bowel adenocarcinoma
hyposplenism
Lactose intolerance
Subfertility

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13
Q

Small bowel bacterial overgrowth syndrome (SBBOS)/SIBO

A

disorder characterised by excessive amounts of bacteria in the small bowel resulting in gastrointestinal symptoms.

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14
Q

Risk factors for SIBO

A

neonates with congenital gastrointestinal abnormalities
scleroderma
diabetes mellitus

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15
Q

SIBO clinical presentation

A

chronic diarrhoea
bloating, flatulence
abdominal pain

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16
Q

SIBO Ix

A

hydrogen breath test
small bowel aspiration and culture
clinicians may sometimes give a course of antibiotics as a diagnostic trial

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17
Q

First-line medication for SIBO

A

rifaximin

(Co-amoxiclav or metronidazole are also effective in the majority of patients)

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18
Q

Clostridium difficile infection

A

Clostridium difficile (CDI) is a gram positive bacteria that causes pseudomembranous colitis

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19
Q

Common antibiotic risk factors for Clostridium difficile infection

A

Clindamycin
Ciprofloxacin
Cephalosporins
Penicillins

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20
Q

Clostridium difficile infection clinical presentation

A

Watery diarrhoea, which can be bloody
Painful abdominal cramps
Nausea
Signs of dehydration
Fever
Loss of appetite and weight loss
Confusion

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21
Q

C Diff infection Mx

A
  1. Vancomycin 125mg PO QDS
  2. Second line is Fidamomicin 200mg PO BD
  3. Other options for treatment resistent or life-threatening infection include using higher doses of oral Vancomycin or adding PO/IV Metronidazole
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22
Q

Diverticula vs Diverticulosis vs Diverticular disease vs Diverticulitis

A

Diverticula: small bulges/pouches in bowel wall
Diverticulosis: presence of diverticula without symptoms.
Diverticular disease: diverticula cause symptoms, such as intermittent pain in the lower tummy
Diverticulitis: inflammation/infection of diverticula , causes more severe symptoms

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23
Q

Risk factors for diverticular disease

A

Age >50
Lack of fibre
Smoking
Obesity
Constipation
Long term regular use of painkillers such as ibuprofen or aspirin
Fhx

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24
Q

Diverticular disease epidemiology

A

85% of people > 80 years
Associated with western low fibre diet
Occur in the sigmoid colon in 85%

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25
Diverticular disease clinical presentation
Pain - Left iliac fossa intermittent gets worse during or shortly after eating (pooing or farting eases it) tenderness Diverticula can press on bladder causing increased urination Abdominal bloating in diverticular disease Diarrhoea or constipation or both Fever PR painless blood / mucus Nausea and vomiting
26
Gastrointestinal differentials for diverticular disease
IBS, gastroenteritis, appendicitis, ischaemic colitis, IBD, bowel obstruction, colorectal cancer, coeliac disease
27
Gynaecological differentials for diverticular disease
pelvic inflammatory disease, ovarian cyst torsion ( sharp stabbing lower abdo pain/pelvic pain with N+V), ectopic pregnancy
28
Diverticular disease Ix
Blood tests- Leukocytosis & high CRP CT scan - first line AXR- perf Abdominal ultrasound- if CT not poss Contrast enema Colonoscopy Angiogram and/or isotope labelled red blood cell nuclear scan - in acute bleeding Blood culture - if septic
29
Symptomatic diverticular disease Mx
high-fibre diet 30g weight loss and smoking cessation bulk-forming laxatives avoid NSAIDs and opioid analgesia (such as codeine) if possible, due to the potential increased risk of diverticular perforation Abx if infection
30
Diverticulitis Mx
fluid-only diet/very low-fibre diet to rest your digestive system for a few days Hospital admission will include antibiotics, analgesia and fluid resuscitation May require surgical resection if severely septic / peritonitic or develops complications
31
Diverticulitis Cx
Haemorrhage Perforation and peritonitis Abscess Fistula Ileus / obstruction
32
Appendicitis pathophysiology
- Luminal obstruction leads to distension of the appendix owing to increased mucus production, bacterial overgrowth, and suppurative inflammation. - Lymph glands and tissues swell as they cant drain - This results in impaired venous drainage from the appendix due to compression - There is increased oedema and swelling, with eventual ischaemia and necrosis, and potential perforation
33
Appendicitis clinical presentation
Periumbilical/epigastric pain that worsens, and migrates to the RLQ aggravated by movement Low-grade fever Nausea, vomiting Anorexia Change in bowel habits
34
Psoas sign
right lower quadrant pain elicited on stretching of the iliopsoas muscle individual lying on their left side while their right thigh is flexed backward, pain triggers the individual to shorten the muscle by drawing up the right knee
35
obturator sign
pain elicited in an individual by flexing their right knee to a 90 degree angle while a clinician internally rotates the hip by moving the ankle away from the body
36
Rovsing's sign
palpation in the LIF causes pain in the RIF in appendicitis
37
Apendicitis Ix
Bloods: WCC neutrophils, UE, CRP, urinalysis, abdo US Dx: alvarado score ( symptoms + raised WCC and neutrophils)
38
Apendicitis Imaging
CT scan US - Thickened wall of appendix, excludes gynae Axr - perf
39
Apendicitis Mx
Abx Appendectomy
40
Differentials for appendicitis
Ectopic Pregnancy Ovarian Cysts- rupture/torsion Meckel’s Diverticulum- children under 2y Mesenteric Adenitis Appendix Mass Gastroenteritis IBD
41
Pellagra
deficiency of vitamin B3, niacin dermatitis (sunburn-like rash) diarrhoea dementia (cognitive deficit/delusion)
42
Consequences of vitamin B6 deficiency
peripheral neuropathy sideroblastic anemia seizures isoniazid therapy can cause the deficiency
43
Beriberi
due to a thiamine (vitamin B1) deficiency categorized into wet beriberi (presenting with tachypnoea, dyspnoea and pedal oedema) and dry beriberi (presenting with pain, paresthesia and confusion). Wernicke–Korsakoff syndrome is a subtype of dry beriberi.
44
Vitamin A deficiency
first presentation is with night blindness and xerophthalmia (risking corneal ulceration)
45
Scurvy
due to vitamin C deficiency. presents with anaemia, bleeding gums and bruising/petechiae
46
Familial adenomatous polyposis
Mutation of APC gene Annual flexible sigmoidoscopy from 15 years If no polyps found then 5 yearly colonoscopy started at age 20
47
MYH associated polyposis
Multiple colonic polyps Later onset right sided cancers more common 100% cancer risk by age 60 Once identified resection and ileoanal pouch reconstruction is recommended Associated with increased risk of breast cancer
48
HNPCC (Lynch syndrome)
autosomal dominant condition, is the most common form of inherited colon cancer. Germline mutations of DNA mismatch repair genes Colo rectal cancer 30-70% Endometrial cancer 30-70% Gastric cancer 5-10% Colonoscopy every 1-2 years from age 25 Consideration of prophylactic surgery
49
Peutz-Jeghers syndrome
mutation in the STK11 gene and has an autosomal dominant inheritance pattern. Patients typically present in their teens with mucocutaneous pigmentaiton and hamartomatous polyps low risk of neoplastic transformation
50
colorectal 2ww referral
40 years and over with unexplained weight loss and abdominal pain, or 50 years and over with unexplained rectal bleeding, or 60 years and over with: - Iron-deficiency anaemia, or - Changes in their bowel habit, or Tests show occult blood in their faeces. people with a rectal or abdominal mass.
51
Risk factors for colorectal cancer
Obesity Processed meat Alcohol Smoking Sugar Longstanding IBD age radiation T2D
52
Colorectal cancer Left sided lesions symptoms
Change in bowel habit ( frequency, consistency) Constipation ( left colon is narrower more likely to become obstructed than right) Dark red rectal bleeding, may be bright red Abdominal pain Passing mucus Tenesmus Less advanced at presentation
53
Colorectal cancer right sided lesions symptoms
Anaemia Diarrhoea Abdominal bloating Midgut colic Abdominal pain is a late symptom
54
Colorectal cancer Ix
Colonoscopy CT colonography Conventional CT Flexible sigmoidoscopy MRI PET CEA ( carcinoembryonic antigen) tumour marker
55
Bowel cancer screening
FIT test 60 to 74 years every 2 years
56
Dukes A classification
Confined to mucosa and part of the muscle of the bowel wall (i.e. not beyond the muscularis).
57
Dukes B classification
Extending through the muscle of the bowel wall
58
Dukes C:
Lymph node involvement
59
Dukes D:
Metastatic disease
60
Colorectal cancer Mx
almost always involves surgical resection chemo postoperatively or neoadjuvant radiotherapy not used because colon is moving target palliative care can involve colonic stent for obstructing left side tumours
61
Rectal cancer mx
Radiotherapy
62
Stomach cancer OGD 2ww
in people: With dysphagia, or Aged 55 years and over with weight loss and any of the following: Upper abdominal pain Reflux Dyspepsia
63
Epidemiology gastric cancer
Sixth most common fatal cancer in the UK Men highest incidence in Far East
64
Types of gastric cancer
>90% are adenocarcinomas 40% found in antrum
65
Risk factors for stomach cancer
Genetics Pylori (intestinal type gastric cancer) Excessive intake of salted food Dietary nitrosamines (found in smoked foods ) Smoking, alcohol Pernicious anaemia Blood group A
66
Signs of gastric cancer
Palpable epigastric mass Virchow’s node – palpable left lymph node in supraclavicular fossa indicates metastatic disease Ascites, jaundice Acanthossi nigricans Sister Mary joseph Nodule – painful palpable nodule into umbilicus Blumer’s shelf dermatomyositis skin rash
67
Mx gastric cancer
Surgery neoadjuvant chemoradiotherapy Endoscopic mucosal resection (EMR) for early cases

Medicine (72 decks)

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