gastroenterology Flashcards
1
Q
define achalasia
A
failure to relax LOS
2
Q
symptoms of achalasia
A
dysphagia of solids AND liquids
regurgitation, heart burn
raised lower eosphageal sphincter pressure
3
Q
diagnostic of alchalasia
A
gold: manometry
other: OGD, barium swallow (eso dilated, bird peak)
4
Q
treatment of achalasia
A
POEM (pneumatic ballon dilatation)
dilatation and myotomy
5
Q
complication of achalasia
A
aspiration pneumonia
6
Q
diagnostic for GORD
A
pH studies
OGD (oesophagogastroduodenoscopy)
7
Q
treatment for GORD
A
PPI (omeprazole 40mg) + life style
H2 antagonist
surgery (nissen fundoplication)
8
Q
define hiatus hernia
A
stomach bulges up into your chest through an opening in your diaphragm
risk factor of GORD
9
Q
treatment for hiatus hernia
A
anti-reflux surgery if patient has severe reflux/esophagitis
10
Q
symptoms of peptic ulcer
A
epigastric pain, dyspepsia, heartburn
11
Q
diagnostic of peptic ulcer
A
H.pylori testing (stool antigen, urease)
endoscopy
12
Q
treatment of peptic ulcer
A
amoxicillin + clarithromycin + PPI
metronidazole+ clarithromycin + PPI
13
Q
treatment for bleeding peptic ulcer
A
- resuscitation (ABC)
- endoscopic: mechanical clips and thermal coagulation with adrenaline
- medical: PPI
14
Q
causes of esophageal varices
A
portal hypertension
15
Q
treatment of bleeding esophageal varices
A
- resuscitation (ABC)
- endoscopic: 1. band ligation 2.TIPSS
- medical: terlipressin, prophylactic antibiotic therapy
propranolol to prevent future bleeding
16
Q
types of esophageal cancer
A
Squamous cell carcinoma (upper 2/3)
Adenocarcinoma (lower 1/3, Barrett’s oesophagus)
17
Q
symptoms of esophageal cancer
A
progressive dysphagia
haematestasis
weight loss
hoarse voice
18
Q
typical presentation of esophageal cancer
A
old men smoking for years, new onset of dysphagia to solids but not liquids
19
Q
diagnostic and staging of esophageal cancer
A
endoscopy+ biopsy
staging: CT, PET scan
20
Q
treatment of esophageal cancer
A
endoscopic resection
surgery + chemo
21
Q
treatment of eosinophilic esophagitis
A
steroids
montelukast
22
Q
cause of gastritis
A
bacterial: H.pylori
chemical: NSAID
autoimmune: anti-parietal/intrinsic factors antibodies
23
Q
types of gastric cancer
A
intestinal adenocarcinoma
diffuse adenocarcinoma
lymphoma
24
Q
investigations of gastric cancer
A
endoscopy + biopsy (signet ring)
25
gastric cancer associated with H.pylori
intestinal adenocarcinoma
| lymphoma
26
symptoms of Mallory weiss tear
large amount of red blood coughed up
| Melena
27
characteristics of Crohn's symptoms
```
No blood or mucus
Entire GI tract
“Skip lesions” on endoscopy
Terminal ileum most affected
Transmural inflammation
Smoking is a risk factor (don’t set the nest on fire)
```
28
symptoms of Crohns
diarrhea
| abdominal tender
29
characteristics of UC
```
Continuous inflammation
colon and rectum
superficial mucosa affected
Smoking is protective
Excrete blood and mucus
PSC
```
30
symptoms of UC
nocturnal symptoms
diarrhea with blood
tenesmus
left iliac fossa pain
31
manifestations/ complications of Crohns
mouth ulcer
| fistula, gallstones
32
histological findings of Crohns
non-ceasesting granulomas
increase goblet cells
Cobblestone
rose thorn ulcers
33
manifestation/ complications of UC
toxic megacolon
arthritis
PSC
34
histological findings of UC
crypt abscess
| pseudopolyps
35
diagnostic of IBD
gold: endoscopy + biopsy
Faecal calprotectin (released by the intestines when inflamed) is a useful screening test (> 90% sensitive and specific to IBD in adults)
36
treatment of Crohns
induce remission: Steroids (e.g. oral prednisolone or IV hydrocortisone)
maintain remission: Azathioprine, Mercaptopurine
37
treatment of Crohns: surgery
effect only distal ileum
Surgery can also be used to treat strictures and fistulas secondary to Crohns disease.
38
treatment of UC to induce remission
Mild to moderate disease
aminosalicylate (mesalazine)
prednisolone
Severe disease
IV hydrocortisone
39
treatment of UC: maintain remission
Maintaining Remission
Aminosalicylate (e.g. mesalazine oral or rectal)
Azathioprine
Mercaptopurine
40
IBS risk factor
young women with mental health problems and past gastroenteritist
41
IBS symptoms
constipation/ diarrhea with no blood
42
diagnostic of IBS
ROME IV
faecal calptoetin: not elevated in IBS, elevated in IBD
FBC, ESR, CRP: normal in IBS
43
ROME IV for IBS
```
ab pain 1/week, for 3 months
2/3:
pain defeaction
change in appearance of stool
change in frequency of stool
```
44
treatment for IBS
antispasmodic/ depressants for pain relief
IBS-C: bulk forming laxative, ie, ispagula husk
IBS-D: loperamide, rifaximin
45
typical presentation of coeliac disease
person who has diarrhea and bloating after eating gluten, who has osteoporosis, dermatitis herpetiformis, and ulceration
46
diagnosis for coeliac disease
serology: looks at IgA w/ antiTTGA.
| endoscopy+ biopsy
47
diagnostic result of coeliac disease
decrease igA
villous atrophy
crypt hypertorphy
48
diagnostic of colon cancer
colonoscopy/ sigmoidoscopy
49
symptoms of colon cancer
right: iron deficient, RIF mass
| left (common): rectal bleeding, LIF mass
50
genetic associations of colon cancer
HNPCC: DNA mismatch repair gene (Lynch syndrome)
APC: tumour supressor gene (growth of FAP, a polyp)
51
genetic mutation from adenoma to adenocarcinoma of colon cancer
APC-> COX2-> KRAS-> P53-> loss of 18q
52
what is rosving's sign
appendicitis
| RIF fossa pain on palpation of LIF
53
drinking limit
14 units per week
54
what are the 3 phases of alcoholic liver disease
1. alcohol related fatty liver
2. alcohol hepatitist
3. cirrhosis
55
symptoms of alcoholic liver disease
```
jaundice, hepatomely, ascites
spider nave
palmar erythema
gynaecomastia
caput medusa
anticoagulopathy
hepatocytes encephalopathy
```
56
diagnostic of alcoholic liver disease
Liver biopsy: confirm diagnostic
LFT: ^ALT/ AST
Fibroscan: elasticity of liver, for cirrhosis testing
57
scoring systems used for cirrhosis
child-pugh: severity of cirrhosis
| MELD: every 6 months for compensated cirrhosis
58
complications of cirrhosis
```
portal hypertension and varices
ascites and spontaneous bacterial peritonitis
hepato-renal syndrome
hepatic encephalopathy
HCC
```
59
treatment for portal hypertension and varices
propranolol for portal hypertension
| elastic band ligation for stable varices
60
treatment for ascites and SBP
ascites: decrease Na+, spironolactone (anti aldosterone diuretics)
SBP: IV cefotaxime
61
what is Hepatic encephalopathy+ treatment
build up of toxin such as ammonia in brain causing confusion
laxative: lactulose for ammonia exertion
antibiotic: rifaxminin reduce intestinal bacteria producing ammonia
62
development of non-alcoholic fatty liver disease
NAFLD-> non-alcoholic steatohepatitis (NASH)-> fibrosis-> cirrhosis
63
NAFLD diagnostic
enhanced liver fibrosis (not available in many areas)
| liver ultrasound: diagnosis of hepatic steatosis (^ echogenicity)
64
viral hepatitis symptoms
jaundice
vomit
diarrhea
abdominal pain
65
viral hepatitist diagnostic
serology: relevant igM during onsets
LFT: increase ALT & AST with low albumin
66
hepatitist B diagnostic: acute vs chronic vs immuned
acute: HBsAg, HbeAg, igG, igM
chronic: HBsAg (6months), igG
immuned: anti-HBsAg,
67
hepatitist C diagnostic
serology: HCV antibody (screening)
PCR: HCV RNA, negative=past infection, positive= active infection (diagnostic)
68
hepatitis B treatment
antivirals: tenofovir/ entecavir, PegIFN-alpha
69
hepatitis C treatment
DAA 8-12 weeks
70
cause of PBC
immune system attack intrahepatic small ducts causing obstruction of cholesterol, bilirubin, bile acid flow
71
symptoms of PBC/PSC
jaundice + pale stool
xanthomas
pruitist+ greasy stool
72
risk factors of PBC
middle age woman with immune/ rheumatoid diseases
| ie, coeliac, thyroid, rheumatic arthritis
73
diagnostic of PBC
LFT: increase ALP
| anti-AMA
74
treatment of PBC
```
ursodeoxycholic aid (decrease cholesterol absorption)
colestryamine (pruritus from bile acid)
```
75
main difference between PBC and PSC?
typical patient
| PSC: 30-40 men with UC and family history of PSC
76
diagnostic of PSC
MRCP magnetic resonance cholangiopancretography (MRI scan of liver, bile ducts, pancreas)
p-ANCA
LFT: increase ALP
77
management of PSC
liver transplant
ERCP
colestyramine
monitor: HCC, cirrhosis, varices
78
define haemochromatosis
genetic mutation of HFE protein on chromosome 6 causing iron build up
79
symptoms of haemochromatostsis
chronic tiredness
pigmentation
joint pain
later in woman
80
diagnostic of haemochromatostasis
serum ferritin + transferrin saturation
| genetic testing
81
treatment of haemochromatostasis
venesection (removing blood to decrease iron)
monitor serum ferritin
no alcohol
82
define Wilsons disease
mutation of ATP7B copper binding protein on chromosome 13 causing copper build up
83
symptoms of Wilsons disease
chronic hepatitist+ cirrhosis
dysarthria+ dystonia
Kayser-Fleischer rings
84
diagnostic of Wilsons disease
serum caeruloplasmin: low levels
| liver biopsy: gold standard
85
treatment of Wilsons disease
penicillamine
| trentene
86
cause of alpha-1-antitrypsin deficiency
autosomal recessive mutation in A1AT on chromosome 14
87
what does alpha-1-antitrypsin do? and what happens during deficiency
inhibit protease such as neutrophil elastase
| deficiency: excessive protease to attack liver and lungs
88
diseases caused by alpha-1-antitrypsin
liver cirrhosis after 50
| bronchiectasis and emphysema after 30
89
diagnosis of alpha-1-antitrypsin
low serum alpha 1 antitrypsin
genetic testing for A1AT
liver biopsy
high resolution CT thorax
90
treatment of alpha-1-antitrypsin
stop smoking
| manage symptoms and monitor complications
91
what are the 3 layers of mucosa
epithelium
lamina propria
muscularis mucosa
92
four layers inner to outermost layer of GI tract
mucosa
submucosa
muscular externa
serosa
93
what are the 2 types of tissues in muscularis externa
inner circular muscle
| outer longitude muscle
94
what are the 2 types of tissue in serosa
areolar connective tissue
| simple squamous
95
function of the mucosa (epithelium)
exo+ endocrine cells: secretion of enzymes, hormones, digestive juice
96
function of mucosa (lamina propria)
gut associated lymphoid: Peyer's patches, defence against pathogens
97
function of mucosa (muscular mucosa)
contraction allowing different absorption of luminal contents
98
contents of submucosa
major blood and lymphatic vessels
| submucosal/ meissner's plexus (enteric nervous system)
99
contents of muscular externa
inner: narrowing the lumen help mixing of digestive content
myenteric/ Auerbach's plexus (contain ICC, enteric nervous system)
outer: propel food down
100
complex molecules and their digestive forms (carbs, protein, lipids)
carbohydrates-> glucose, galactose, fructose (absorbed by enterocytes)
protein-> small peptide and amino acids
triglycerides-> monoglycerides and free fatty acids
101
function of exocrine glands in secretion
secrete enzymes and digestive juices into the lumen helping digestion and absorption of nutrients
102
function of endocrine glands in secretion
secrete hormones into blood, regulate function of digestive tract
103
define peristalsis
involuntary contraction and relaxation of the bowel: under neurohormonal control
104
what are the 4 contributors to neurohormonal mechanisms in digestive system
smooth muscle pacemaker cells
enteric nervous system
autonomic nervous system
hormones
105
describe smooth muscle pacemaker cells in the GI
ICC/intestinal cells of cajal: deliver slow wave potentials with varying intrinsic rate depending on location
106
how does slow wave potentials from ICC work
rhythmic fluctuations in membrane potential bring smooth muscle closer or further away from threshold
107
what happens when threshold is reached for smooth muscles
action potentials fired=depolarization of muscle fibres and coordinated contraction via gap junctions
108
describe the enteric nervous system
intramural nervous system unique to digestive tract providing local control
subset of autonomic nervous system
submucosal + myenteric plexus
sensory neurones + effector neurones
109
function of sensory vs effector neurones in enteric nervous system
sensory: detect local alteration
effector: muscular contraction, exocrine gland secretion, hormone release
110
describe Hirschsprung's disease
congenital absence of submucosal and myenteric plexuses leading to absence of peristalsis, dilatation of proximal colon and constipation
111
functions of the autonomic nervous system effect on the GI tract
control digestive tract
| modify effect of intrinsic nerve plexus and hormonal release
112
parasympathetic control of GI
vagus nerve
secretion of acetylcholine binding to muscarinic receptors
increase motility + promotes secretion
113
sympathetic control of GI
splanchnic nerves
| release of catecholamines: decrease motility and inhibit secretions
114
function of hormones in GI
secreted by endocrine glands into bloods
| simulator or inhibitory actions on muscular contraction and secretion
115
what are the three salivary ducts
sublingual
submandibular
parotid
116
features of sublingual gland
facial nerve (12)
small ducts in the floor of the mouth
smallest gland
117
features of submandibular gland
facial nerve (12)
Wharton's duct
frenulum on the underside of the tongue
118
features of the parotid glands
glossopharyngeal nevre (9)
pre-auricular area
stensen's duct at 2nd superior molar
119
function and location of cardiac glands
lower esophageal splinter
mucous cells producing alkaline mucous protecting epithelium of stomach
act as lubricant
120
function and location of oxyntic glands
body and fundus of the stomach
| contain exocrine cells: mucous, chief, parietal
121
function of chief cells
secret proenzyme pepsinogen-> activated by HCI into pepsin breaking down polypeptides into peptide fragments
122
function of parietal cells
HCI (hydrochloric acid): acidic stomach pH2, activate pepsinogen, denature and breakdown molecules
intrinsic factor acids: absorb vitamin B12
123
what is crucial occurrence during end of gastric phase of digestion
gastric emptying of chyme into duodenum actives D cells in the stomach to release somatostatin decrease gastric secretion
124
what are the 2 enterogastrones released when chyme enters duodenum
secretin
| CCK
125
features of secretin
secreted by s cell in duodenum and jejunum
| stimulates pancreas to secret alkaline fluid w/ HCO to neutralize acidic chyme entering duodenum
126
features of CCK
secreted by I cells from duodenum
| stimulate pancreatic release of zymogen granules (amylase + lipase + proteolytic enzyme)
127
test to confirm H.pylori eradication
The 13C urea breath test
128
compare and contrast gallstones and cholecystitis
```
both middle aged female
obstructive jaundice (gall) vs non obstructive jaundice (chole)
```
129
typical presentation of ascending cholangitist
Charcot's triad (jaundice, fever, RUQ pain)
| gram negative rod infection
130
Charcot's triad
biliary obstruction
jaundice
fever
RUQ pain
131
symptoms of cholecyctist
Murphy's sign (patient take and hold in a deep breath while palpating right subcostal area, if pain occurs= positive sign)
RUQ pain
132
diagnostic of choleycystist
ultrasound (MRCP if need further diagnosis)
| ^ALP
133
upper GI endoscopy vs oesophageal manometry
Endo: cancer, tumours (progressive dysphagia)
mano: spasm (intermitted dysphagia to liquids and solids)
134
symtpoms and treatment of UC complication toxic megacolon
fever
severe abdominal pain
anti-diarrhoea agent taken
abdominal X-ray
135
diagnostic of HCC
raised alpha fetoprotein (AFP)
ultrasound scan: focal lesions
CT: hypervascularity
136
causes of pancreatitis
alcohol abuse
NSAID
complication of ERCP
137
symptoms of pancreatitis
abdominal pain radiating to the back, worse laying down
Cullen’s sign - periumbilical bruising
Grey Turner’s sign - flank bruising
fever
138
diagnostic of pancreatitis
serum amylase 3x normal level
| amylase > 1000
139
transudative vs exudative ascites
Exudates: fluid cellular substances discharge from blood vessels usually from inflamed tissues
Transudates: fluids that pass through membrane to tissue/ extracellular space
140
examples transudative vs exudative ascites
Exudative: malignancy, infection, inflammation
transudative: portal hypertension, CHF, hypoalbuminemia
141
define vitamin B12 & deficiency
produce RBC
meat, fish, dairy
absorbed in ileum
deficiency: glossitis, jaundice, depression
142
define vitamin B1 & deficiency
thiamine deficiency, alcoholics
horizontal nystagmus on lateral gaze
Wernicke's encephalopathy (confusion)
143
alcohol withdrawal symptoms and treatment
```
delirium tremens (hallucinate, sweating)
oral lorazepam
```
144
presentation of diverticulitst
elderly patient with left iliac fossa pain
pouches of inflammation in intestines
lead to abscess and perforation if not treated
145
UC severity scoring system
Truelove and Witts
146
common sign of biliary colic
pain worse after big/ fatty meal due to gallbladder contracting to secret bile following a meal (gall stones presence makes this painful)
147
biliary colic vs gallstone
biliary colic is cause by gall stones passing through the biliary tree
both have same risk factors, symptoms, diagnostic
148
difference between biliary colic vs other gallstone related conditions
no fever
| normal LFT/ inflammatory markers
149
diagnostic of biliary colic
ultrasound
| dilated common bile duct
150
where are inguinal hernias located
superior and medial to public tubercle
151
where are femoral hernias located
inferior and lateral to public tubercle
152
describe peristalsis in the oesophagus
circular smooth muscle contract behind the food bolus and longitudinal smooth muscle propel food through the oesophagus
153
primary vs secondary peristalsis
primary: spontaneously move food from the oesophagus to stomach (9sec)
secondary: food which doesn't enter the stomach stimulates stretch receptors to cause peristalsis
154
causes of acute pancreatitis
gall stones and ERCP
ethanol, steroids, drugs
mumps and scorpion
155
what are Blatchford vs Rockall for and difference
upper GI bleed
blatchford: first line
Rockall: pre and post endoscopy score
156
what is ABC in resuscitation
A: airway
B: breathing
C: circulation
157
what is airway in resuscitation
airway is patent and protected
158
what is breathing in resuscitation
oxygen saturation
resp rate
breath sounds
159
what is circulation in resuscitation
blood pressure/ HR, ecg
establish IV access (2 wide bored cannula)
blood tests
IV fluid/ blood products if needed
160
what does NSAID inhibit and how does it cause gastritis
inhibit COX 2 for anti-inflammatory effect, however, it is non-selective and also inhibit COX 1 which helps production of prostgaldins
COX1 inhibition= increase in histamine
161
what is the function of prostaglandins
inhibit ECL cells that secrete histamine
162
how does increase in histamine cause gastritis
histamine secretion is one method of stimulating HCI which irritates gastric mucosa causing gastritis/ esophageal reflux
163
what is the ligament of treitz
anatomical division for foregut from midgut
| located in duodenal segment D2
164
define Lynch disease
autosomal dominant disease associated w/ high risk of colorectal cancer
diagnosed with genetic testing
165
what and where is gastrin produced
antrum of stomach by G cells
166
raised biomarker for acute pancreatitis
Amylase
167
common features of pancreatic cancer
adenocarcinoma
| painless jaundice
168
mode of action: PPI (ie, omeprazole)
inhibits gastric parietal cell H+/k+ ATPase
169
define Budd-chiari syndrome
occlusion of hepatic vein from blood clot
ab pain, ascites, hepatomegaly
lupus erythematosus+ contraceptive pill
170
treatment for C.diff
metronidazole
| vancomycin
171
what monosaccharides are sucrose, lactose, maltose
sucrose: glucose + fructose
lactose: glucose + galactose
malstose glucose+ glucose
172
function of parietal cells in the stomach
produced intrinsic factor / absorb B12
| secreted HCI
173
how are gallstones formed
1. cholesterol stones due to bile contains high cholesterol + low bile salts
2. pigement stones due to excess bilirubin
3. 80% of gallstones are mixed - pigment and cholesterol
174
purpose of NGT (nasogastric tube )
internal feeding/ medication administration
| decompression of stomach
175
testing before NGT placements
chest angiography
| pH studies
176
what does child Pugh look for
encephalopathy
ascites
bilirubin
prothrombin time
177
define Zollinger Ellison syndrome
gastrin-secreting tumour/ hyperplasia of islet cells in the pancreas
overproduction of gastric acid-> repeat peptic ulcers
178
diagnostic of Zollinger Ellison
bloods: abnormal gastrin
| ultrasound
179
Zollinger Ellison symptoms
diarrhea
heartburn
burning or dull pain in the abdomen
180
norovirus features
explosive D+V
short incubation (< 24h)
cruise ships
181
rotavirus feature
young kids
| D+V
182
clostrium difficile features
normal bacterial flora
4c antibiotic induced-> allows C. diff to overgrow
toxin A (enterotoxin) and toxin B (cytotoxin)
183
Bacillus cereus features
starchy foods:reheated rice
| profuse vomiting
184
Campylobacter jejuni
most common bacterial cause of foodborne
poultry, unpasteurized milk
travel to SE Asia
185
shigella vs e.coli
both: bloody diarrhea, HUS
| E.coli: travel + beef
186
what is HUS: haemolytic uremic syndrome
low RBCs, low platelets, high WBCs and acute kidney failure
| E. coli 0157, Shigella and Salmonella
187
define anal fissure
Tear in the mucosa of the anal canal, inside the anal margin
| if there are multiple may be due to crohns
188
symptoms of anal fissure
serve anal pain lasting about 30min after constipation
189
treatment of anal fissure
dietary advice and stool softener
| sphincterectomy
190
define perianal fistula
Abnormal connection between the anal canal and the perianal skin from delayed/inadequate treatment of anorectal abscesses
191
presentation of perianal fistula
patient with cronhs comes in with Painful tender swellings and Discharge in the perineum, including mucus, blood, pus, or faeces
192
diagnostics of perianal fistula
EUA of anorectum
| Proctoscopy to visualize the opening of the tract
193
perianal fistula treatment
Surgically excised then drained
| Followed up with antibiotics
194
haemorrhoids definition
abnormally enlarged vascular mucosal cushions in the anal canal
195
haemorrhoids risk factors
constipation
^age
Raised intra-abdominal pressure (e.g. pregnancy, chronic cough, ascites)
196
where are internal haemorrhoids found
above dentate line, where the rectum joints the anus
197
where are external haemorrhoids found
below the dentate line, found at the anal opening and are covered by skin
198
symptoms of haemorrhoids
Painless bright red rectal bleeding
Perianal itchiness
No change in bowel habit, no weight loss or other associated symptoms
199
diagnostics of haemorrhoids
PR exam and Proctoscopy
| Flexible sigmoidoscopy in patients over 50 or where malignancy is a possibility
200
treatment of haemorrhoids
Stool softeners, fibre diet, Topical creams
Rubber-band ligation
HALO/THD procedure
201
define rectal prolapse
The walls of the rectum protrude through the opening of the anus and become visible
202
2 type of rectal prolapse thickness
Partial thickness:rectal mucosa protrudes out of the anus
| Full thickness:rectal wall protrudes out the anus
203
some symptoms of rectal prolapse
Protruding mass from anus during defeacation
Bleeding and passing mucus
poor anal tone
204
diagnostic of rectal prolapse
Barium enema, colonoscopy
