Gastroenterology Flashcards
Give consequences of a low vitamin A
blindness
Give consequences of a low vitamin B1
Beri beri
wet - heart failure
dry - neuropathy
Give consequences of a low vitamin B3
niacin
Pellagra - diarrhoea / dementia / dermatitis
Give consequences of a low vitamin C
Scurvy
bleeding
Poor healing
function of G cells
Secrete gastrin - stimulates parietel cells to produce HCL
Function of D cells
Secrete somatostatin - inhibits G cells
Function of chief cells
secrete pepsinogen
2 factors delaying gastric emptying
CCK - also stimulates gallbladder
Secretin - also stimulates pancreas
Where else is somatostatin released other that the stomach
Pancreas - Delta cells
Function of CCK
Delays gastric emptying
stimaultes gallbladder contraction
stimulates sphincter of Oddi
RF for chrons disease
FHx
Jewish
T1DM
RF for chrons disease
FHx
Jewish
Chronic stress
Sx and signs of chrons disease
sx
- weight loss
- RIF abdominal pain
- Diarrhoea
signs
- clubbing
- pallor
- Apthous ulcers
- RIF Tenderness / mass
- PR fistulae / mass / skin tag
extraintestinal features of crohns
Erythema nodosum
Pyoderma gangrenosum
Gallstones
Arthiritis
Anterior uveitis
Features of anterior uveitis and mangement
Acute red eye
Ciliary flush
Reduced visual acuity
Small fixed oval pupil
Photophobia
Iris
Ciliary body
Choroid
Mx - urgent opthamology r/v
Cyclopentolate
Atropine
Dilate pupil to prevent pain
Management of crohns
C - Smoking cessation
M-
Induce
PO/IV steroids
Mesalazine
Infliximab
Maintain
Azathiporine
MXT
Complications of crohns
osteoporosis
Abscess
strictures
small bowel cancer
colorectal carcinoma
Complications of crohns
osteoporosis
Abscess
Fistula
strictures
small bowel cancer
colorectal carcinoma
sx and signs of UC
sx
- LLQ pain
- tenesmus and urgency
- Diarrhoea
- blood and mucus
- weight loss
Clubbing
Pallor
RLQ mass and tenderness
PSC
- Jaundice + pruritus
Features of PSC
Jaundice
Pruritus
Increased bilirubin
Increased ALP
RUQ pain
P-ANCA
Ix - MRCP
Microscopic features of UC
Pseudopolyps - ulceration with preserved adjacent mucosa
colon only
circumfrential and continuous
Macroscopic features of UC
Pseudopolyps - ulceration with preserved adjacent mucosa
colon only
circumfrential and continuous
Microscopic features of UC
Decreased goblet cells
No granuloma
crypt abscess
mucosal inflammation only
barium enema findings of UC
Lead pipe colon
Loss of haustral markings
Management of UC - induce
Induce
Mild/mod
- distal - topical mesalazine
extensive
- topical
- PO
Severe - IV steroids
Manageemnt of UC - Maintenance
Mild/mod -
distal - meslazine
extensive PO
severe - PO Azathiprine
What is toxic megacolon
toxic non obstructive dilatation of colon
tenderness and distension
Complications of PSC
Biliary stricure
cholangiocarcinoma
hepatitis
LF
Fat soluble vitamin def
Management of PSC
Liver transplant can be curative but is associated with its own problems
ERCP can be used to dilate and stent any strictures
Colestyramine is a bile acid sequestrate in that it binds to bile acids to prevent absorption in the gut and can help with pruritus due to raised bile acids
Features of IBS
Abdominal pain relieved by defication or associated with change in bowel habit
+
Abnormal passage of stool
mucus PR
Bloating
sx worse after eating
Ix for IBS
FBC - CRP / WCC
Feacal calpotectin
coeliac serology
IBS management
Fluids / smaller meals / decrease alcohol / FODMAP / CBT
Cramps - Hycosine butylbromide
TCA
SSRI
define coeliac disease
AI mediated disorder due to insensitivity to proteins in gluten causing chronic inflammation - Type 4 hypersensitivity
Sx of coeliac disease
abdominal pain
bloating
N+V
Diarrhoea
greasy smelly stooly
weight loss
fatigue
signs of coeliac disease
FTT
Short stature
wasted buttocks
Pallor - Anaemia
dermatitis hepatiformis - elbows / knees / buttocks
abdominal distension
angular stomatitis
bloating
Complications of coeliac disease
IDA
B12 / Folate
Hyposplenism
osteoperosis
T cell lymphoma
Investigations of coeliac disease
Stool culture
IgA level
Bloods - faceal calprotection / FBC / Anti TTG
OGD and biopsy
Findings on biopsy of coeliac
villous atrophy
crypt hyperplasia
lyphocyte infiltration
features of peritonism
rebound tenderness
percussion tenderness
guarding
rigidity
sx of appendicitis
periumbilical –> RIF pain
Fever
N+V
Dysuria
Diarrhoea
signs of appendicitis
Mc burneys point sign
Rovsign sign
Obturator sign - pain in RIF on internal hip rotation
Psoas sign - pain in RIF on hip extension
Investigations in appendicitis
Urine dip and urinalysis
FBC / CRP / U+E / Clotting / G&S
VBG - Lactate
Urine HCG
CXR
USS - Female
CT
Define:
Diverticulum
Diverticulosis
Diverticular disease
Diverticulitis
Outpouching of colonic mucosa and submucosa
Presence of multiple diverticula
Presence of multiple symptomatic diverticula
Inflammation of diverticula
RF for diverticulosis
Increasing age
Low fibre diet
chronic constipation
obesity
NSAIDs
Presentation of diverticular disease
LIF pain
chronic constipation - altered bowel habit
PR bleeding
management of diverticular disease
hydration
high fibre diet
bulk forming laxative
presentation of acute diverticulitis
pain and tenderness in LLQ
Fever
diarrhoea
N+V
PR bleeding
Investigations for diverticulitis
Bloods - WCC / CRP
AXR
CT
Management of diverticulitis
PO Co-amoxiclav
what is a haemorrhoid
swollen vascular cushion in anal canal
classification of haemorrhoids
upper 2/3rds - painless
rectal columnar epithelium
lower 1/3rd - Painful and itchy
stratified squamous
RF for haemorrhoids
prolonged sitting
obesity
constipation
increased age
sx of haemorrhoids
painless PR bleed
perianal irritation
mucosal discharge
management of haemorrhoids
conservative
- prevent constipation
- increase fibre / fluid
medical
- laxatives
surgical
- topical anaesthetics and steroids
- rubber band ligation
Risk factors for GORD
Obesity
Pregnancy
Hiatus hernia
Smoking
Alcohol
NSAIDs
Caffeine
Definition of GORD
Regurgitation of contents into oesophagus due to relaxation of LOS
Sx and signs of GORD
Sx
Heartburn
Dyspepsia
Regurgitation - worse when lying down
Epigastric pain
cough
What is toxic megacolon
toxic non obstructive dilatation >6cm
Abdo tenderness
Distension
Causes of clubbing
CHD - Cyanotic
CF
Lung cancer
UC
Bronchiectasis
IE
IPF
Crohns
what is acute mesenteric ischemia
thrombus / embolus blocking mesenteric ischaemia
RF - AF
Sx out of keeping with clinical presentation
Ix
- metabolic acidosis
- 1st line CT angiogram
- GOLD - Colonoscopy
Mx
- IV Abx + Heparin + surgery
what is pseudomembranous colitis
inflammation of colon due to overgrowth of C.Diff
RF for pseudomembranous colitis
Clindamycin
PPI
Hospital admission
sx of pseudomembranous colitis
diarrhoea
abdominal pain
Raised WCC
Toxic megacolon
management of psudomembranous colitis
Vancomycin
Fidaxomicin
recurrent
12 weeks - fidoxamicin
life threatening
vancomycin + metronidazole
SBO features
- causes
- sx
- signs
- Ix
Adhesions / Henria / Crohns stricture
Colicky abdominal pain
N+ Bilious vomiting
Abdominal distension
constipation
no flatulence
abdo tenderness
tinkling bowel sounds
AXR - >3cm / valvulae all across
CT with contrast
AXR in bowel obstrcution
Both
- fluid level in bowel
- no air in distant bowel
- distended bowel loops
Small
- valvuale seen all across
large
- loss of haustra
causes of LBO
Malignancy
Volvulus
Hernia
Diverticular disease
Intusussception
What is pseudo-obstruction
non mechanical dilatation of bowels due to paralytic ileus
causes of pseudo-obstruction
Post op - paralytic ileus
Parkinsons disease
Opiates
electrolyte imbalances
recent trauma or surgery
Hirschprung
causes of appendictis
faecolith
foreign bodies
lymphoid hyperplasia
signs of appendicitis
Rovsings
rebound tenderness
guarding
Psoas sign
Obturator - hip flexion and internal rotation
Investigations in appendicitis
Bloods
- WCC / CRP
Urinalysis
Pregnancy test
Abdominal USS - Children and pregnant women
Abdominal CT with contrast
Investigations in appendicitis
Bloods
- WCC / CRP / lactate
Urinalysis
Pregnancy test
Abdominal USS - Children and pregnant women
Abdominal CT with contrast
Post gastroenteritis complications
lactose intolerance
IBS
Reative arthiritis
GBS
Features of anal fissure
throbbing pain worse on sitting
pruritus ani
blood / mucus in stool
features of oesophageal cancer
progressive dysphasia
weight loss
hoarse voice
odynophagia
ALARMS
features of gastric cancer
Antrum and lesser curvature
RF: Male / older / smoking / Pernicious aneamia / H pylori
Epigastric pain
wt loss
N+V
Dysphasia
Lymphatic spread - virchows node
RF for colon cancer
FAP - Multiple polyps
Lynch syndrome - HNPCC
Smoking
Obesity
Alcohol
IBD
Sx and signs of bowel cancer
Change in bowel habit
weight loss
PR bleeding
Tenesmus
Abdominal pain
ALARM
PR - Rectal mass
Abdominal mass
Screening for colon cancer
FIIT Test
Aged 60 -74 every 2 years
what cell type is affected in small bowel cancer
Enterochromaffin
