Gastroenterology Flashcards
What is achalasia?
Problem- degeneration of Myenteric plexus supplying the lower oesophagus - increased tone of lower oesophageal sphincter (doesn’t relax) - impaired peristalsis
What are the symptoms of achalasia?
- Difficulty swallowing solids and liquids from the start
- Chest pain
- Weight loss
- Heartburn but no improvement with acid suppression
- Regurgitation of food - aspiration
What is Zenker’s diverticulum? and how does it present?
a.k.a pharyngeal pouch
Usually occurs in the posterior pharyngeal wall
actually a false diverticulum (as it does not include all 3 layers of the oesophageal wall only the submucosa and mucosa)
- dysphagia
- halitosis
- feeling food sticking in the throat
- regurgitation of undigested food
- hoarse voice
- chronic cough
- choking and can have recurrent aspiration pneumonia
Coeliac disease increases the risk of which cancer?
intestinal lymphoma
Ulcerative colitis increases the risk of which biliary condition?
Primary sclerosing cholangitis
What is primary sclerosis cholangitis
- strongly associated with UC
- inflammation of bile ducts leading to fibrosis and structuring - leads to biliary OBSTRUCTION and cholestasis - bile backs up and damages the liver - can lead to cirrhosis
- increases risk of cholangiocarcinoma
- ALP and GGT are high
Patient’s with UC are at increased risk of which cancer?
colorectal cancer
What is the cause of familial adenomatous polyposis?
Autosomal mutation of APC gene on chromosome 5 (tumour suppressor gene)
What’s the treatment for familial adenomatous polyposis?
prophylactic colectomy
Hereditary nonpolyposis colorectal cancer
autosomal dominant
mutation in DNA mismatch repair (MMR) genes –> microsatelite instability
onset of colorectal cancer at earlier age - typically in absence of polyps
also increases risk of endometrial
, gastric, and ovarian cancer
What is the treatment of Wilson’s disease?
A copper chelating agent such as PENICILLAMINE
What are some extra-intestinal manifestations of ulcerative colitis?
- primary sclerosing cholangitis
- polyarthritis
- EYES - uveitis,
- pyoderma gangrenosum
- erythema nodosum.
What is the most common cause of large bowel obstruction?
colorectal cancer
Most common cause of small bowel obstruction
- adhesions from previous surgery (60%)
- malignancy
- crohn’s
- incarcerated hernia
Femoral hernia
- femoral hernia is more common in women than men
- but in women, inguinal hernias are still more common than femoral
- highest incidence in middle aged women
- lump in the groin and inferior to the pubic tubercle
- femoral hernias are at increased risk of strangulation
Most common type and site of colorectal cancer
- adenocarcinoma
- site: rectum
What is the difference between cholecystitis and cholangitis
Cholecystitis - acute inflammation of the gallbladder
associated with fever, systemically unwell, raised WCC and CRP
associated with positive Murphy’s sign
Cholangitis - acute infection of biliary tree due to obstruction (by stone, stricture, or complication of ERCP)
Inflammatory features as above + jaundice
what is Charcot’s triad
Ascending cholangitis
1. Jaundice
2. Fevers
3. RUQ pain
what is Murphy’s sign?
A sign of acute cholecystitis
Palpate RUQ
Ask the patient to take a deep breath in
If they get pain on inspiration this is a positive sign - due to the inflamed gallbladder hitting your hand
Rockall score
- age
- signs of shock
- comorbidities
- diagnosis- Mallory Weiss tear, stigmata of recent haemorrhage, malignancy of upper GI tract
- stigmata of acute bleeding
Carcinoid syndrome can lead to deficiency in which vitamin?
Niacin vitamin b3
What is Pellagra and what are the symptoms
Caused by Niacin deficiency (B3)
1. Dermatitis
2. Diarrhoea
3. Dementia
What is carcinoid syndrome?
Neuroendocrine tumours are derived from enterochromaffin cells which are ubiquitous in the body
Carcinoid syndrome most commonly occurs as a complication of neuroendocrine tumours in the GI tract that have metastasised to the liver
Tumours secrete high levels of serotonin
You get increased tryptophan metabolism to produce serotonin so you can end up with niacin deficiency (niacin is derived from tryptophan)
What are the symptoms of carcinoid syndrom
- cutaneous flushing
- recurrent diarrhoea due to
↑ bowel motility - abdominal cramps
- asthma-like wheezing
- symptoms of pellagra
treatment: surgical resection of the tumour
octreotide
Primary biliary cholangitis (PBC)
Autoimmune
- fatigue
- pruiritis
- obstructive symptoms - jaundice, pale stools, dark urine
- hepatomegaly
- xanthelasma
- can progress to cirrhosis
anti-mitochondrial antibodies are highly specific
Treatment with ursodeoxycholic acid
Liver transplantation
What are the differences between PBC and PSC?
PBC
- inflammation and damage to intrahepatic bile ducts –> bile stasis –> damage to the liver
- No increased cancer risk
- good response of Ursodeoxycholic acid - improves prognosis
PSC
- inflammation and damage to intrahepatic AND extra-hepatic bile ducts
- strongly associated with IBD
- Pts with IBD and PSC are at increased risk of colorectal cancer
- increases risk of cholangiocarcinoma
MALT lymphoma is associated with what infection?
H.Pylori
What is the gold standard test for H.Pylori infection
Urea breath test
(stool antigen test cannot distinguish between previous or current infection)
What are the classic LFTs in alcoholic hepatitis?
AST:ALT ratio of > 2:1
Cholestasis pattern of LFTs?
Very high ALP and Bilirubin compared with AST/ALT
(ALP high when biliary tree affected)
What investigations do you do for obstructive LFTs?/
- US scan
- MRCP
- ERCP
What type of cancer is oesophageal cancer
- upper 2/3 of oesophagus - squamous cell carcinoma
- lower 1/3 - adenocarcinoma
What are the symptoms of Riboflavin deficiency (B2
)?
dermatitis, glossitis, and fissures at the corner of the mouth (cheilosis).
Corneal vascularisation
What are the key features of haemochromatosis?
Sx are caused by iron overload
- cirrhosis
- diabetes
- skin pigmentation - bronzing
- Cardiomyopathy
High serum iron and ferritin
Transferrin saturation high
Liver biopsy with Prussian blue staining reveals hemosiderin deposits.
What is Boerhaave’s syndrome?
Oesophageal rupture
Leads to pneumomediastinum
What is the gold standard for diagnosing achalasia?
Eosophageal manometry
findings include increased LES pressure, inability of the LES to relax, decreased peristalsis, and diffuse esophageal spasm
What is the treatment for achalasia
endoscopic balloon dilation of LES
cure rate of 80%
complication of perforation in < 3% of patients
myotomy with fundoplication
similar outcomes to that of dilation
Botox injections are second line
