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Medicine > Gastroenterology > Flashcards

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
Q

Diverticular disease clinical presentation

A

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

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26
Q

Gastrointestinal differentials for diverticular disease

A

IBS, gastroenteritis, appendicitis, ischaemic colitis, IBD, bowel obstruction, colorectal cancer, coeliac disease

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27
Q

Gynaecological differentials for diverticular disease

A

pelvic inflammatory disease, ovarian cyst torsion ( sharp stabbing lower abdo pain/pelvic pain with N+V), ectopic pregnancy

28
Q

Diverticular disease Ix

A

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
Q

Symptomatic diverticular disease Mx

A

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
Q

Diverticulitis Mx

A

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
Q

Diverticulitis Cx

A

Haemorrhage
Perforation and peritonitis
Abscess
Fistula
Ileus / obstruction

32
Q

Appendicitis pathophysiology

A
  • 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
Q

Appendicitis clinical presentation

A

Periumbilical/epigastric pain that worsens, and migrates to the RLQ
aggravated by movement
Low-grade fever
Nausea, vomiting
Anorexia
Change in bowel habits

34
Q

Psoas sign

A

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
Q

obturator sign

A

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
Q

Rovsing’s sign

A

palpation in the LIF causes pain in the RIF in appendicitis

37
Q

Apendicitis Ix

A

Bloods: WCC neutrophils, UE, CRP, urinalysis, abdo US
Dx: alvarado score ( symptoms + raised WCC and neutrophils)

38
Q

Apendicitis Imaging

A

CT scan
US - Thickened wall of appendix, excludes gynae
Axr - perf

39
Q

Apendicitis Mx

A

Abx
Appendectomy

40
Q

Differentials for appendicitis

A

Ectopic Pregnancy
Ovarian Cysts- rupture/torsion
Meckel’s Diverticulum- children under 2y
Mesenteric Adenitis
Appendix Mass
Gastroenteritis
IBD

41
Q

Pellagra

A

deficiency of vitamin B3, niacin
dermatitis (sunburn-like rash)
diarrhoea
dementia (cognitive deficit/delusion)

42
Q

Consequences of vitamin B6 deficiency

A

peripheral neuropathy
sideroblastic anemia
seizures

isoniazid therapy can cause the deficiency

43
Q

Beriberi

A

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
Q

Vitamin A deficiency

A

first presentation is with night blindness and xerophthalmia (risking corneal ulceration)

45
Q

Scurvy

A

due to vitamin C deficiency. presents with anaemia, bleeding gums and bruising/petechiae

46
Q

Familial adenomatous polyposis

A

Mutation of APC gene
Annual flexible sigmoidoscopy from 15 years
If no polyps found then 5 yearly colonoscopy started at age 20

47
Q

MYH associated polyposis

A

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
Q

HNPCC (Lynch syndrome)

A

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
Q

Peutz-Jeghers syndrome

A

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
Q

colorectal 2ww referral

A

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
Q

Risk factors for colorectal cancer

A

Obesity
Processed meat
Alcohol
Smoking
Sugar
Longstanding IBD
age
radiation
T2D

52
Q

Colorectal cancer Left sided lesions symptoms

A

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
Q

Colorectal cancer right sided lesions symptoms

A

Anaemia
Diarrhoea
Abdominal bloating
Midgut colic
Abdominal pain is a late symptom

54
Q

Colorectal cancer Ix

A

Colonoscopy
CT colonography
Conventional CT
Flexible sigmoidoscopy
MRI
PET
CEA ( carcinoembryonic antigen) tumour marker

55
Q

Bowel cancer screening

A

FIT test 60 to 74 years every 2 years

56
Q

Dukes A classification

A

Confined to mucosa and part of the muscle of the bowel wall (i.e. not beyond the muscularis).

57
Q

Dukes B classification

A

Extending through the muscle of the bowel wall

58
Q

Dukes C:

A

Lymph node involvement

59
Q

Dukes D:

A

Metastatic disease

60
Q

Colorectal cancer Mx

A

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
Q

Rectal cancer mx

A

Radiotherapy

62
Q

Stomach cancer OGD 2ww

A

in people:
With dysphagia, or
Aged 55 years and over with weight loss and any of the following:
Upper abdominal pain
Reflux
Dyspepsia

63
Q

Epidemiology gastric cancer

A

Sixth most common fatal cancer in the UK
Men
highest incidence in Far East

64
Q

Types of gastric cancer

A

> 90% are adenocarcinomas
40% found in antrum

65
Q

Risk factors for stomach cancer

A

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
Q

Signs of gastric cancer

A

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
Q

Mx gastric cancer

A

Surgery
neoadjuvant chemoradiotherapy
Endoscopic mucosal resection (EMR) for early cases

Medicine (72 decks)

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