Gastroenterology Flashcards
Which mnemonic helps differentiate Crohn’s disease and what does it stand for?
NESTS
N: No blood or mucus (PR bleeding less common)
E: Entire GI tract affected
S: Skip lesions on endoscopy
T: Terminal ileum most affected and Transmural inflammation
S: Smoking is a risk factor
Which mnemonic helps differentiate ulcerative colitis and what does it stand for?
CLOSEUP:
C: Continuous inflammation
L: Limited to colon and rectum
O: Only superficial mucosa affected
S: Smoking may be protective
E: Excrete blood and mucus
U: Use aminosalicylates
P: Primary sclerosing cholangitis
What condition is ulcerative colitis particularly associated with?
Primary sclerosing cholangitis.
What skin conditions can occur with inflammatory bowel disease?
Erythema nodosum
Pyoderma gangrenosum
What eye conditions are associated with IBD?
Episcleritis
Scleritis
Anterior uveitis
What stool test is around 90% sensitive and specific for IBD in adults?
Faecal calprotectin.
What is the investigation of choice for diagnosing IBD?
Colonoscopy with multiple intestinal biopsies.
What is the first-line treatment for mild to moderate acute ulcerative colitis?
Aminosalicylates (e.g., oral or rectal mesalazine).
What is the first-line treatment for severe acute ulcerative colitis?
Intravenous steroids (e.g., IV hydrocortisone).
What surgical procedure is curative for ulcerative colitis?
Panproctocolectomy (removal of the large bowel and rectum).
What are the two surgical options after a panproctocolectomy?
Permanent ileostomy
Ileo-anal anastomosis (J-pouch)
What is the first-line treatment for inducing remission in an exacerbation of Crohn’s disease?
Steroids (e.g., oral prednisolone or IV hydrocortisone).
What is an alternative treatment to steroids for inducing remission in Crohn’s disease, especially in children?
Enteral nutrition.
What are the first-line options for maintaining remission in Crohn’s disease?
Azathioprine
Mercaptopurine
What are the surgical options for Crohn’s disease?
Resecting the distal ileum
Treating strictures
Treating fistulas
List three red flag features in GORD (in addition to dysphagia) that may indicate a need for an urgent two-week wait referral.
Weight loss
Treatment-resistant dyspepsia
Upper abdominal mass on palpation
What is the most common type of hiatus hernia?
Sliding hiatus hernia (Type 1).
What bacteria is associated with gastritis, ulcers, and an increased risk of stomach cancer?
Helicobacter pylori (H. pylori).
Name two methods used to test for H. pylori infection.
Stool antigen test
Urea breath test
What is the typical treatment for H. pylori infection?
Triple therapy with a proton pump inhibitor and two antibiotics (e.g., amoxicillin and clarithromycin) for 7 days.
What is Barrett’s oesophagus and why is it significant?
Barrett’s oesophagus is a condition where the lower oesophageal epithelium changes from squamous to columnar, increasing the risk of oesophageal adenocarcinoma.
What is the treatment for Barrett’s oesophagus to monitor or prevent progression to cancer?
Endoscopic monitoring
Proton pump inhibitors
Endoscopic ablation (e.g., radiofrequency ablation)
What is Zollinger-Ellison syndrome?
A rare condition where a duodenal or pancreatic tumour secretes excessive gastrin, leading to severe dyspepsia, peptic ulcers, and diarrhoea.
What genetic condition is associated with Zollinger-Ellison syndrome?
Multiple endocrine neoplasia type 1 (MEN1).
What types of medications increase the risk of bleeding from a peptic ulcer?
Non-steroidal anti-inflammatory drugs (NSAIDs)
Aspirin
Anticoagulants (e.g., DOACs)
Steroids
SSRI antidepressants
How can chronic microscopic bleeding from a peptic ulcer affect the blood?
It can lead to iron deficiency anaemia, resulting in low haemoglobin, low mean cell volume (MCV), and low ferritin.
What is gastric outlet obstruction and how does it present?
Gastric outlet obstruction is a narrowing of the stomach exit due to scarring and strictures, leading to early fullness after eating, upper abdominal discomfort, abdominal distension, and vomiting after meals.
How can gastric outlet obstruction be treated?
It may be treated with balloon dilatation during an endoscopy or surgery.
How can you differentiate between gastric and duodenal ulcers based on eating patterns and pain?
Eating worsens the pain in gastric ulcers, while in duodenal ulcers, pain improves immediately after eating but worsens 2-3 hours later.
What is the most common cause of upper gastrointestinal bleeding? Name four other potential sources of upper GI bleeding.
Peptic ulcers.
Mallory-Weiss tear (tear of the oesophageal mucosa)
Oesophageal varices (due to portal hypertension in liver cirrhosis)
Stomach cancer
Gastritis or esophagitis
What factors does the Glasgow-Blatchford score take into account?
Haemoglobin
Urea
Systolic blood pressure
Heart rate
Presence of melaena
Syncope
Liver disease
Heart failure
What is the purpose of the Rockall score?
It estimates the risk of rebleeding and mortality after endoscopy.
What factors does the Rockall score include?
Age
Features of shock (e.g., tachycardia, hypotension)
Co-morbidities
Cause of bleeding
Endoscopic findings of recent bleeding
What does the mnemonic ABATED stand for in the management of upper GI bleeding?
A – ABCDE approach
B – Bloods (FBC, U&Es, INR, LFTs, crossmatch)
A – Access (2 large bore cannulas)
T – Transfusions (as needed)
E – Endoscopy (within 24 hours)
D – Drugs (stop anticoagulants and NSAIDs)
When are platelets given in UGIB?
When there is active bleeding plus thrombocytopenia (platelet count <50).
What is given to patients on warfarin who are actively bleeding?
Prothrombin complex concentrate.
What additional treatments are needed if oesophageal varices are suspected?
Terlipressin
Broad-spectrum antibiotics
When should a proton pump inhibitor (PPI) be used in upper GI bleeding?
After endoscopy for non-variceal bleeding, as per NICE guidelines (2016).
What criteria are required for an IBS diagnosis according to NICE?
A history of at least 6 months of abdominal pain or discomfort with one of the following:
- Pain or discomfort relieved by opening the bowels
- Bowel habit abnormalities
- Stool abnormalities (e.g., watery, loose, or hard)
and At least two of the following:
- Straining, urgency, or incomplete emptying
- Bloating
- Symptoms worse after eating
- Passing mucus
What is recommended for constipation in IBS?
Bulk-forming laxatives (e.g., ispaghula husk). Lactulose should be avoided due to bloating.
What is prescribed for abdominal cramps in IBS?
Antispasmodics such as mebeverine, alverine, hyoscine butylbromide, or peppermint oil.
Which antibodies are related to Coeliac Disease?
Anti-tissue transglutaminase antibodies (anti-TTG)
Anti-endomysial antibodies (anti-EMA)
Anti-deamidated gliadin peptide antibodies (anti-DGP)
Which human leukocyte antigen (HLA) genotypes are associated with Coeliac Disease?
HLA-DQ2 and HLA-DQ8.
What skin condition is associated with Coeliac Disease?
Dermatitis herpetiformis, an itchy, blistering skin rash, often on the abdomen.
What neurological symptoms can rarely present with Coeliac Disease?
Peripheral neuropathy
Cerebellar ataxia
Epilepsy
What is the first-line blood test for diagnosing Coeliac Disease?
Total immunoglobulin A (IgA) levels
Anti-tissue transglutaminase antibodies (anti-TTG)
What are the main complications of untreated Coeliac Disease?
Nutritional deficiencies
Anaemia
Osteoporosis
Hyposplenism (increased infection risk)
Ulcerative jejunitis
Enteropathy-associated T-cell lymphoma (EATL)
Non-Hodgkin lymphoma
Small bowel adenocarcinoma
