Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

finals > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What epithelium lines the oesophagus ?

A
  • Non keratanised stratified squamous epithelium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what plexus controlks the instrinsic peristaltic movement of the oesophagus ?

A

Enteric plexus : consists of an outer myenteric plexus and inner submucosal plexus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Explain the pathophysiology behind achalasia

A
  • Loss of inhibitory ganglion cells of the myenteric plexus in the distal oesophagus and LOS.
  • Leads to a failure of peristalsis and relaxation of the LOS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How does Achalasia present ?

A
  • Dysphagia of BOTH liquids and solids
  • Heartburn, unresponsive to Tx
  • Regurgitation of undigested food
  • Weight loss
  • Chest pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the initial Ix for achalasia ?

A
  • Barium swallow -> will show dilated oesophagus with narrowing at LOS (birds beak)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the diagnostic investigation for achalasia ?

A
  • Oesophageal manometry
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is pseuodachalasia ?

A
  • Obstruction of the distal oesophagus by something other than destruction of myenteric plexus
  • Caused by : malignancy, scleroderma, strictures.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the endoscopic treatment options for achalasia ?

A
  • Pneumatic (balloon) dilation
  • Intra-sphincteric injection of botulinum toxin (inhibits Ach release, preventing contraction).
  • Perioral endoscopic myotomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the surgical treatment options for achalasia ?

A

Heller cardiomyotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the medical treament options for achalasia ?

A
  • CCB (nifedipine)
  • Long acting nitrates
  • They act to reduce lower oesophageal pressure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What kind of malignancy are patients with achalasia for >10yrs at an increased risk of ?

A
  • Squamous cell carcinoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What factors can exacerbate / worsen Sx of GORD

A
  • Greasy and spicy foods
  • Coffee and tea
  • Alcohol
  • NSAIDs
  • Stress
  • Smoking
  • Obesity
  • Hiatus hernia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the symptoms of GORD

A
  • > Dyspepsia
    • Heartburn
    • Acid regurg
    • Retorsternal / epigastric pain
    • Bloating
    • Nocturnal cough
    • Hoarse voice
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Red flags for 2 wk wait OGD

A
  • Dysphagia (difficulty swallowing) at any age gets an immediate two week wait referral
  • Aged over 55 (this is generally the cut-off for urgent versus routine referrals)
  • Weight loss
  • Upper abdominal pain
  • Reflux
  • Treatment-resistant dyspepsia
  • Nausea and vomiting
  • Upper abdominal mass on palpation
  • Low haemoglobin (anaemia)
  • Raised platelet count
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Stepwise management of GORD

A
  1. Lifestyle changes
  2. Reviewing medications (e.g., stop NSAIDs)
  3. Antacids (e.g., Gaviscon, Pepto-Bismol and Rennie) – short term only
  4. Proton pump inhibitors (e.g., omeprazole and lansoprazole)
  5. Histamine H2-receptor antagonists (e.g., famotidine)
  6. Surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Lifestyle changes for GORD

A

Reduce tea, coffee and alcohol
Weight loss
Avoid smoking
Smaller, lighter meals
Avoid heavy meals before bedtime
Stay upright after meals rather than lying flat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what should be ruled out when treating GORD

A
  • H. pylori -> gram neg aerobic bacteria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

H.pylori eradication

A
  • Triple therapy
  • PPI (e.g., omeprazole)
    Two antibiotics (e.g., amoxicillin and clarithromycin) for 7 days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Complication of GORD

A
  • Barrett’s oesophagus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Epithelial changes in Barrett’s

A

squamous to columnar epithelium = metaplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Management of Barrett’s

A
  • Endoscopic monitoring for progression to adenocarcinoma
  • PPI
  • Endoscopic ablation (e.g., radiofrequency ablation)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Rare condition causing severe dyspepsia, diarrhoea and peptic ulcers

A
  • Zollinger-Ellison Syndrome
  • Duodenal or pancreatic tumour secretes excessive gastrin
  • Gastrin = stimulates acid secretion in the stomach
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

RF for peptic ulcers

A

-> Disrupting mucus barrier = H.pylori, NSAIDs
-> Increasing stomach acid = stress, alcohol, caffeine, smoking, spicy foods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How do peptic ulcers present ?

A
  1. Epigastric pain -> worse on eating with gastric, better after eating with duodenal
  2. N&V
  3. Dyspepsia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Signs of UGIB from a peptic ulcer (4)

A
  1. Haematemesis
  2. Melaena
  3. Hypotension
  4. tachycardia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Diagnosis of a peptic ulcer

A
  • Endoscopy with a rapid urease test to check for H.pylori
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Treatment of peptic ulcer

A
  1. Stopping NSAIDs
  2. Treating H. pylori infections
  3. Proton pump inhibitors (e.g., lansoprazole or omeprazole)

Repeat endoscopy 4-8 wks later to ensure healing of ulcer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Complications of a peptic ulcer

A

-> Bleeding
-> Perforation = acute abdominal pain and peritonitis
-> Scaring and strictures = can lead to gastric outlet obstruction = presents with early fullness / upper abdo discomfort / abdo distention and vomiting, particularly after eating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

4 causes of an UGIB

A
  1. Peptic ulcers (most common)
  2. Mallory-Weiss tear
  3. Oesophageal varices
  4. Stomach cancers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

3 presenting features of an UGIB

A
  1. Haematemesis
  2. Coffee ground vomit
  3. Meleana
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What score is used to assess the risk of a pt having an UGIB based on inital presentation ?

A

Glasgow-Blatchford Bleeding Score

  • Haemoglobin (falls in upper GI bleeding)
  • Urea (rises in upper GI bleeding)
  • Systolic blood pressure
  • Heart rate
  • Presence of melaena (black, tarry stools)
  • Syncope (loss of consciousness)
  • Liver disease
  • Heart failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

An isolated rise in what suggest an UGIB

A

UREA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what score is used after endoscopy to estimate the risk of rebledding and mortality in an UGIB

A

-> Rockall score

  • Age
  • Features of shock (e.g., tachycardia or hypotension)
  • Co-morbidities
  • Cause of bleeding (e.g., Mallory-Weiss tear or malignancy)
  • Endoscopic findings of recent bleeding (e.g., clots and visible bleeding vessels)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Initial management of UGIB

A

-> A – ABCDE approach to immediate resuscitation
-> B – Bloods
-> A – Access (ideally 2 x large bore cannula)
-> T – Transfusions are required
-> E – Endoscopy (within 24 hours)
-> D – Drugs (stop anticoagulants and NSAIDs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what bloods are sent in an UGIB

A
  • Haemoglobin (FBC)
  • Urea (U&Es)
  • Coagulation (INR and FBC for platelets)
  • Liver disease (LFTs)
  • Crossmatch 2 units of blood
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what additional medications are given if an UGIB is due to suspected oesophageal varcies ?

A

Terlipressin
Blood spectrum Abx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Features of crohn’s disease

A

NESTS

-> N – No blood or mucus (PR bleeding is less common).
-> E – Entire gastrointestinal tract affected (from mouth to anus).
-> S – “Skip lesions” on endoscopy.
-> T – Terminal ileum most affected and Transmural (full thickness) inflammation.
-> S – Smoking is a risk factor (don’t set the nest on fire).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Features of ulcerative colitis

A

CLOSE UP

-> C – Continuous inflammation
-> L – Limited to the colon and rectum
-> O – Only superficial mucosa affected
-> S – Smoking may be protective (ulcerative colitis is less common in smokers)
-> E – Excrete blood and mucus

-> U – Use aminosalicylates
-> P – Primary sclerosing cholangitis

39
Q

Bloods done in IBD

A
  • Faecal calprotectin
40
Q

Inducing remission in UC

A
  • MILD TO MODERATE : Aminosalicylate (e.g., oral or rectal mesalazine) first-line, Corticosteroids (e.g., oral or rectal prednisolone) second-line
  • SEVERE : IV hydrocortisone
41
Q

Maintaining remission in UC following a mild to moderate flare

A
  • Low maintenance dose of oral aminosalicylate
42
Q

Inducing remission in crohn’s

A

Oral pred or IV hydrocortisone first line

43
Q

Maintaining remission in crohn’s

A
  • First line : azathioprine or mercaptopurine
44
Q

3 key features of IBS

A

-> I – Intestinal discomfort (abdominal pain relating to the bowels)
-> B – Bowel habit abnormalities
-> S – Stool abnormalities (watery, loose, hard or associated with mucus)

45
Q

Autoantibodies involved in coeliac disease

A

-> Anti-tissue transglutaminase antibodies (anti-TTG)
-> Anti-endomysial antibodies (anti-EMA)
-> Anti-deamidated gliadin peptide antibodies (anti-DGP)

46
Q

Seen on endoscopy in coeliac disease

A
  • Villous atrophy
  • Crypt hyperplasia
  • Jejunum most affected
47
Q

Genotypes associated with coeliac disease

A

HLA-DQ2
HLA-DQ8

48
Q

Presenting symptoms of coeliac disease

A

-> Failure to thrive in young children
-> Diarrhoea
-> Bloating
-> Fatigue
-> Weight loss
-> Mouth ulcers

49
Q

Skin rash seen in coeliac disease

A

Dermatitis herpetiformis : itchy, blistering skin rash, typically on the abdomen

50
Q

Neurological symptoms seen in coeliac disease

A

-> Peripheral neuropathy
-> Cerebellar ataxia
-> Epilepsy

51
Q

First line blood tests for coeliac disease

A
  • Total immunoglobulin A levels (to exclude IgA deficiency)
  • Anti-tissue transglutaminase antibodies (anti-TTG)
52
Q

what does coeliac disease increase the risk of

A

-> Enteropathy-associated T-cell lymphoma (EATL)
-> NHL
-> Small bowel adenoacarcinoma

53
Q

Long term PPI use can cause disturbance in which electrolyte and what could be the presenting symptoms ?

A
  • Hypomagnesaemia
  • Muscle aches
54
Q

Leading cause of c.diff

A

Second and third generation cephalosporins

(PPI are also RF)

55
Q

Expain features of mild, moderate, severe and life threatening C. diff infection

A
  • Mild : normal WCC
  • Moderate : Raised WCC, 3-5 loose stool
  • Severe : WCC (>15), creatinine >50% baseline, temp >38.5 or evidence of colitis
  • Life threatening : hypotension, partial or complete ileus, toxic megacolon
56
Q

Management of 1st episode of C.diff

A
  • 1st : 10 days oral vancomycin
  • 2nd : oral findaxomicin
  • 3rd : oral vancomycin +/- IV metronidazole
57
Q

management of recurrent c.diff infection

A
  • Within 12 weeks of symptom resolution: oral fidaxomicin
  • After 12 weeks of symptom resolution: oral vancomycin OR fidaxomicin
58
Q

Management of Life threatening c.diff infection

A

Oral vancomycin and IV metronidazole

59
Q

Mantaining remission in UC following a severe relapse or >=2 exacerbations a year

A
  • oral azathioprine or oral mercaptopurine
60
Q

Histological findings in crohn’s

A
  • Transmural inflammation
  • Increased goblet cells
  • Granulomas
61
Q

Histological findings in UC

A
  • Neutrophils migrate through the walls of glands to form crypt abscesses
  • Depletion of goblet cells and mucin from gland epithelium
  • Granulomas are infrequent
62
Q

Carcinoembryonic antigen is a tmour marker for what

A

colorectal cancer

63
Q

Recognised complications of enteral feeding

A
  • Diarrhoea
  • Aspiration
  • Metabolic : refeeding / hyperglycaemia
64
Q

Alcohol excess
Severe epigastric pain
Raised amylase

A

Pancreatitis

65
Q

Management of mild acute pancreatitis (stable vital signs)

A

IV fluids (v important)
Opioid analgesia

66
Q

Lifestyle measures for constipation

A

Increase fibre
Adequate fluid
Adequate activity level

67
Q

1st line management of constipation

A

Bulk forming laxative (isphagula husk)

68
Q

Second line for constipation

A

Osmotic (e.g. macrogol)

69
Q

Refeeding syndrome

A
  • Metabolic abnormalities that occur following extended period of starvation
70
Q

metabolic abnormalities of refeeding syndrome

A

Hypophosphataemia
Hypokalaemia
Hypomagnesaemia
Abnormal fluid balance

71
Q

Pathophysiology of refeeding

A
  1. Long period of catabolism ends with reintorudction of carbohydrates.
  2. Leads to increased insulin secretion and increased cellular uptake of glucose
  3. This cause phosphate to move intracellularly = low phosphate serum levels.

= Cardiac dysrhythmia, resp failure, rabdomyolysis, seizures

72
Q

high risk of refeeding

A

One or more of

  1. BMI < 16 kg/m2
  2. nintentional weight loss >15% over 3-6 months
  3. little nutritional intake > 10 days
    4 Hypokalaemia, hypophosphataemia or hypomagnesaemia prior to feeding (unless high)
73
Q

High risk of fefeeding

A

2 or more of

  1. BMI < 18.5 kg/m2
  2. Unintentional weight loss > 10% over 3-6 months
    3.Little nutritional intake > 5 days
  3. History of: alcohol abuse, drug therapy including insulin, chemotherapy, diuretics and antacids
74
Q

4 RF for gastric cancer

A
  1. H.pylori
  2. Atrophic gastritis
  3. High salt diet
  4. Smokinh
75
Q

5 Sx of gastric cancer

A
  • Vague epigastric pain
  • Weight loss and anorexia
  • N&V
  • Dysphagia
  • UGIB
76
Q

Lymphatic spread seen in gastric cancer

A
  • Left supraclavicular (Virchow’s)
  • Periumbilical (Sister mary joseph)
77
Q

Diagnosis gastric cancer

A
  • Oesophago-gastro-duodenoscopy with biopsy ->
    signet ring cells
  • Staging: CT
78
Q

Eradication of h.pylori

A
  • PPI + amoxicillin + (clarithromycin OR metronidazole)
  • If penicillin-allergic: a proton pump inhibitor + metronidazole + clarithromycin
79
Q

Screening tes for malnutrition

A

MUST (Malnutrition Universal Screen Tool).

80
Q

Most common oesophageal cancer

A

Adenocarcinoma

81
Q

4 FR for oesphageal adenocarcinoma

A

GORD
Barrett’s oesophagus
smoking
obesity

82
Q

4 features of oesophageal cancer

A
  • dysphagia: the most common presenting symptom
  • anorexia and weight loss
  • vomiting
  • other possible features include: odynophagia, hoarseness, melaena, cough
83
Q

Diagnosis of oesophageal cancer

A

Upper GI endoscopy with biopsy

84
Q

Plummer vinson sydnrome

A

Triad of:
dysphagia (secondary to oesophageal webs)
glossitis
iron-deficiency anaemia

85
Q

Boerhaave syndrome

A

Severe vomiting → oesophageal rupture

86
Q

Mallory-weiss syndrome

A

syndrome Severe vomiting → painful mucosal lacerations at the gastroesophageal junction resulting in haematemesis. Common in alcoholics

87
Q

Most significant source of UGIB from peptic ulcer disease

A

gastroduodenal artery1

88
Q

1st line for H.pylori test

A

Urea breath or stool antigen

89
Q

Management of more significant diverticulitis

A

Nil by mouth
IV fluid
IV cephalosporin and metronidazole

90
Q

Pharyngeal puch sx

A
  • Dysphagia
  • Regurgitation
  • Aspiration and chronic cough.
    Halitosis may occasionally be seen
91
Q

Investigation of choice for GI ischaemia

A

CT

92
Q

Acute mesenteric ischaemia presentation

A
  • Abdominal pain is typically severe, of sudden onset and out-of-keeping with physical exam findings.
  • Often embolism occluding the superior mesenteric artery or other artery supplying small bowel
  • Hx of AF
  • Urgent surgery needed
93
Q
A

finals (92 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions