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Conditions > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Crohn’s disease: Definition

A

Chronic inflammatory disease affecting any part of gut from mouth to anus

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2
Q

Crohn’s disease: Pathology (2)

A
  1. Transmural granulomatous inflammation
  2. Unaffected areas of bowel between active disease
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3
Q

Crohn’s disease: Part most often affected

A

Terminal ileus

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4
Q

Crohn’s disease: Cause

A

Inappropriate response against the gut flora in a genetically susceptible individual

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5
Q

Crohn’s disease: Typical age of presentation

A

20-40

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6
Q

Crohn’s disease: Environmental associations

A

Smoking (increases risk 3 fold)
NSAIDS

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7
Q

Crohn’s disease: 3 key symptoms

A

Diarrhoea
Abdominal pain
Malnutrition/failure to thrive

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8
Q

Crohn’s disease: 4 key systemic symptoms

A

Fatigue
Fever
Malaise
Anorexia

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9
Q

Crohn’s disease: key signs on examination (2)

A

Abdominal tenderness/mass
Erythema Nodosum

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10
Q

Crohn’s disease: 3 key findings on PR

A
  1. Perianal abscesses, fistulae, skin tags
  2. Bowel Ulceration
  3. Anal strictures
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11
Q

Crohn’s disease: Potential systemic signs on exam (2)

A
  1. Clubbing
    May also present with , skin, joint & eye problems
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12
Q

Crohn’s disease: Complications (4)

A
  1. Small bowel obstruction
  2. Toxic dilatation
  3. Abscess formation
  4. Fistulae
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13
Q

Crohn’s disease: Key blood tests (4)

A
  1. FBC
  2. CRP
  3. U&Es
  4. ferritin, B12, Folate
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14
Q

Crohn’s disease: 2 Key stool tests

A
  1. Stool culture to exclude bacterial cause
  2. Faecal calprotectin (GI inflammation)
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15
Q

Crohn’s disease: Key investigations (3)

A
  1. Colonoscopy and biopsy
  2. Endoscopy
  3. MRI
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16
Q

Crohn’s disease: What can capsule endoscopy be used to investigate?

A

Proximal disease

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17
Q

Crohn’s disease: MRI findings (2)

A

Pelvic disease and fistulae
Small bowel disease activity and strictures

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18
Q

Crohn’s disease: Non-pharmacological management (2)

A

Smoking cessation
Optimise nutrition

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19
Q

Crohn’s disease: Blood test results which are indications for steroid use (4)

A

High HR,
High WCC,
High CRP or low albumin

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20
Q

Crohn’s disease: Mild-moderate Disease treatment (2)

A

Prednisolone (high dose for 1 week, then decrease for 7 weeks)
Diet changes are effective in children

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21
Q

Crohn’s disease: Severe disease treatment (3)

A
  1. IV rehydration
  2. IV steroids (hydrocortisone)
  3. Thromboembolism prophylaxis
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22
Q

Crohn’s disease: Perianal disease epidemiology

A

Occurs in 50% of patients

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23
Q

Crohn’s disease: Perianal disease investigation (2)

A

MRI and examination

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24
Q

Crohn’s disease: Treatment of perianal disease (2)

A

Oral antibiotics
Immunosuppressant therapy (TNF-alpha - iximab)

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25
Q

Crohn’s disease: Azathioprine (type of drug and indication)

A

Immunomodulator
Used if disease is refractory to steroids

26
Q

Crohn’s disease: Anti-TNFalpha (Mechanism of action)

A

Infliximab, Adalimumab
TNF alpha plays key role in Crohn’s pathology
These block the drivers of the immune response

27
Q

Crohn’s disease: Anti-integrin (Mechanism of action)

A

Target molecules involved in lymphocyte trafficking in the gut

28
Q

Crohn’s disease: Indications for surgery (4)

A
  1. Drug failure
  2. GI obstruction due to stricture
  3. Perforation
  4. Fistulae or abcess
29
Q

Primary Biliary Cholangitis: Definition

A

Interlobular bile ducts are damaged by chronic granulomatous inflammation

30
Q

Primary Biliary Cholangitis: Pathophysiology

A

Inflammation may lead to cholestasis which leads to fibrosis, cirrhosis and portal hypertension.

31
Q

Primary Biliary Cholangitis: Aetiology

A

Unknown environmental triggers (?pollutants, xenobiotics) + genetic predisposition leading to loss of immune tolerance to self-mitochondrial proteins

32
Q

Primary Biliary Cholangitis: Testing hallmark of PBC

A

Anti-mitochondrial antibodies

33
Q

Primary Biliary Cholangitis: Associations/aetiology

A

Female gender
Autoimmune diseases
Rheumatoid conditions

34
Q

Primary Biliary Cholangitis: Factors increasing risk (4)

A

Family History
Smoking
Many UTIs
Other immune diseases

35
Q

Primary Biliary Cholangitis: Typical age of presentation

A

Approximately 50

36
Q

Primary Biliary Cholangitis: How is this typically found?

A

Patient usually asymptomatic, and are diagnosed after incidental finding of raised ALP

37
Q

Primary Biliary Cholangitis: What is cholestasis?

A

Obstruction of outflow of bile

38
Q

Primary Biliary Cholangitis: Which chemicals does cholestasis cause to build up? (3)

A

Bilirubin
Bile Acids
Cholesterol

39
Q

Primary Biliary Cholangitis: Effect of bile acid build up

A

Itching

40
Q

Primary Biliary Cholangitis: Effect of bilirubin build up

A

Jaundice

41
Q

Primary Biliary Cholangitis: Effect of Raised cholesterol (2)

A

Cholesterol deposits (Xanthelasma) and increased cardiovascular risk

42
Q

Primary Biliary Cholangitis: 3 signs which may precede Jaundice

A

Lethargy
Sleepiness
Pruritus

43
Q

Primary Biliary Cholangitis: Signs apart from the key 3 (2)

A

Skin pigmentation
Hepatosplenomegaly

44
Q

Primary Biliary Cholangitis: Effect of lacking bile acids in the stool (2)

A

GI disturbance
Greasy stools (fat malabsorption)

45
Q

Primary Biliary Cholangitis: Effect of lack of bilirubin in stool

A

Pale stools

46
Q

Primary Biliary Cholangitis: Possible boney complications (2)

A

Osteoporosis
Osteomalacia (decreased bilirubin in gut)

47
Q

Primary Biliary Cholangitis: Hepatic complications

A

Cirrhosis
Malabsorption of fat soluble vitamins
Hepatocellular carcinoma

48
Q

Primary Biliary Cholangitis: Liver function tests in early disease (3)

A
  1. ALP is the first and most obviously raised
  2. GGT may be raised
  3. Can present with mildly raised AST and ALT
49
Q

Primary Biliary Cholangitis: Liver function tests in late disease (3)

A

High bilirubin
Low albumin
Increased prothrombin time

50
Q

Primary Biliary Cholangitis: Most common autoantibody finding

A

98% are +ve for anti-mitochondrial antibodies

51
Q

Primary Biliary Cholangitis: Auto-antibody which may occur in low-titres

A

Anti-nuclear antibodies (present in 35%)

52
Q

Primary Biliary Cholangitis: Blood tests which are affected (2)

A

Raises IgM
ESR raised

53
Q

Primary Biliary Cholangitis: 5 Key Tests

A
  1. LFTs
  2. Autoantibodies
  3. Other blood tests
  4. Liver biopsy
  5. Ultrasound
54
Q

Primary Biliary Cholangitis: Ultrasound findings

A

Excludes extra hepatic cholestasis

55
Q

Primary Biliary Cholangitis: When might a liver biopsy be used

A

Not usually needed
Can be used for diagnosis and staging or excluding drug-induced cholestasis or hepatic sarcoidosis

56
Q

Primary Biliary Cholangitis: 4 Stages of treatment

A
  1. Urso
  2. Colestryamine
  3. Fat-soluble vitamin prophylaxis
  4. Liver-transplant for end-stage disease
57
Q

Primary Biliary Cholangitis: What is the effect of Urso?

A

Reduces intestinal absorption of cholesterol

58
Q

Primary Biliary Cholangitis: What is the effect of colestyramine?

A

Sequesters bile acids to prevent absorption in the gut - it can help with pruritus

59
Q

Primary Biliary Cholangitis: Monitoring (2)

A
  1. Regular LFTs
  2. Ultrasound and AFP tumour marker (if cirrhosis)
60
Q

Primary Biliary Cholangitis: Most important potential end results of disease (2)

A

Advanced liver cirrhosis
Portal hypertension

Conditions (4 decks)

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