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Medicine > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What is Peptic Ulcer disease?

A

A surface breach of the mucosal lining of the GI tract, occurring as a result of acid and pepsin attack

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2
Q

What is the stool volume in secretory diarrhoea?

A

Very large

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3
Q

What is odynophagia?

A

Painful swallowing

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4
Q

At what level does the superior mesenteric artery arise from the abdominal aorta?

A

L1 vertebra

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5
Q

Which artery supplies the jejenum and ileum?

A

Superior mesenteric artery

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6
Q

What can untreated GORD lead to?

A

Barretts oesophagus

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7
Q

Name two IBD.

A

Crohns disease

Ulcerative colitis

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8
Q

What are the parasympathetic fibres of the stomach?

A

Gastric branches of the left and right vagus nerves

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9
Q

From what does the stomach get sympathetic innervation?

A

Splanchnic nerves

Coeliac ganglion

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10
Q

What is the ion gap in secretory diarrhoea?

A

Less than 100mOsm/kg

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11
Q

What is the most common cause of PUD?

A

H. pylori infection

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12
Q

What are the four layers of the gut?

A

Mucosa
Submucosa
Muscularis externa
Serosa

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13
Q

What are the three types of diarrhoea?

A

Osmotic
Secretory
Inflammatory

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14
Q

What is inflammatory diarrhoea?

A

Diarrhoea occurring when there is damage to the mucosal lining or brush border, leading to passive loss of protein-rich fluids and decrease ability to absorb lost fluids

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15
Q

Name a possible cause of inflammatory diarrhoea.

A

IBD

Infections

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16
Q

What is secretory diarrhoea?

A

Diarrhoea due to an increase in active secretion or an inhibition of absorption

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17
Q

Name a possible cause of secretory diarrhoea.

A

Cholera toxin - stimulates secretion of anions, especially chloride ions

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18
Q

Name symptoms of GORD.

A 
Heartburn
Acid reflux
Dysphagia
Chest pain
Water brash
Odynophagia
Nausea
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19
Q

What happens to osmotic diarrhoea in response to fasting?

A

It stops

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20
Q

What happens to secretory diarrhoea in response to fasting?

A

The diarrhoea continues

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21
Q

What is the main cause of steattorrhoea?

Name something that can cause it.

A

Malabsorption of fat

Pancreatic disease or Coeliac disease

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22
Q

What is osmotic diarrhoea?

A

Water is drawn into the bowels resulting in watery stool

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23
Q

Name a possible cause of osmotic diarrhoea.

A

Maldigestive cause such as coeliac disease

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24
Q

What is GORD?

A

Symptoms of mucosal damage produced by the abnormal reflux of gastric contents into the oesophagus

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25
Q

What is the ion gap in osmotic diarrhoea?

A

More than 100mOsm/kg

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26
Q

What are the symptoms of giardiasis?

A

Steatthorrea

Normally associated with recent travel, for example India

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27
Q

What bacteria can cause traveller’s diarrhoea?

A

ETEC - Enterotoxigenic Escherichia coli

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28
Q

What can sometimes precipitate a C. diff infection?

A

Antibiotic treatment

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29
Q

What types of drugs neutralise stomach acid?

A

Antacids

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30
Q

Name two side effects of alginates and which two products cause them.

A

Constipation (aluminium)

Diarrhoea (magnesium)

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31
Q

What is the mechanism of action of sucralfate and misoprostol?

A

Promote mucosal defense

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32
Q

Name side effects of sucralfate.

A 
Constipation
Reduction in absorption of some drugs
Nausea
Dry mouth
Bezoar formation
Vomiting
Headaches
Rashes
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33
Q

How does misoprostol work?

A

Binds to prostaglandin receptors on parietal cells causing a negative feedback on the proton pump

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34
Q

What is the most common adverse effect of misoprostol?

A

Diarrhoea

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35
Q

Why is misoprostol contraindicated in pregnant women and women of child-bearing age?

A

Can cause partial or complete abortions (due to being PGE1 analog)
Can cause birth defects

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36
Q

What drugs can cause gastric ulceration?

A

NSAIDs

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37
Q

What are metoclopramide and domperidone’s mechanism of action?

A 
Gastric stimulants (increase food transit through stomach)
Act as D2 receptor antagonists
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38
Q

What class of drug inhibit histamine actions at H2 receptors?

A 
H2 receptor antagonists:
Ranitidine
Cimetidine
Nizatidine
Famotidine
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39
Q

What effect do H2 receptor antagonists have?

A

Inhibit gastric secretion

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40
Q

What does PPI stand for and give examples of them.

A 
Proton pump inhibitor:
Omeprazole
Lansoprazole
Pantoprazole
Esomeprazole
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41
Q

How do PPIs work?

A

Irreversibly inhibit action of proton pump, reducing both basal and stimulated gastric acid secretion

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42
Q

Although uncommon, what are some side effects of PPIs?

A

Headaches
Diarrhoea
Rashes

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43
Q

What are some adverse side effects of PPIs?

A 
Pneumonia
Increased risk of C. diff infection
Rebound acid hypersecretion (if drugs stopped)
Increased risk of fracture
Drug interactions
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44
Q

Which bacterial infection is associated with development of gastric and duodenal ulcers and gastric cancers?

A

H. pylori

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45
Q

Name two viruses that may cause diarrhoea.

A

Rotavirus

Norovirus

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46
Q

What is the most likely cause of diarrhoea in a patient who is or has recently been in hospital?

A

C. diff infection

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47
Q

What causes pernicious anaemia?

A

Reduction in vitamin B 12 absorption

48
Q

Which cells in the stomach produce gastrin?

A

G cells

49
Q

Which cells are stimulated by gastrin?

A

Chief cells

Parietal cells

50
Q

Which cells secrete somatostatin and what is its action?

A

D cells

Inhibit gastrin release

51
Q

Where are G cells found?

A

Gastric pits of pyloric antrum

52
Q

Where are chief cells primarily found and what do they produce?

A

Near base of gland

Secrete pepsinogen

53
Q

Where are parietal cells found and what do they secrete?

A

Proximal portion of gland

Secrete hydrochloric acid (H+ via proton pump with Cl-) and intrinsic factor

54
Q

What does intrinsic factor do?

A

Aids in absorption of B12

55
Q

What are the associated symptoms of dyspepsia that can increase cancer risk?

A 
Anaemia
Loss of weight
Anorexia/vomiting
Recent progressive symptoms
Melaena/haematemesis
56
Q

What do prostaglandins regulate in the stomach?

A

Release of bicarbonate and mucous

Maintain mucosal blood flow

57
Q

In a patient with GORD and ‘alarm’ symptoms, how would you investigate?

A

Gastroscopy

Barium swallow

58
Q

What is 24-hour intraluminal pH monitoring reserved for?

A

Confirmation of GORD prior to surgery or in difficult diagnostic cases

59
Q

What would a barium swallow show the presence of?

A

Hiatus hernia

Motility disorders

60
Q

When would a plain abdomen X-ray be used?

A

Investigation of acute abdomen or acute colitis

61
Q

Which abdominal organs is ultrasound a first-line investigation for?

A

Liver
Gall-bladder
Spleen
Pancreas

62
Q

What non-invasive tests are used to investigate H. pylori infection?

A

Urea breath test
Serological tests to detect H. pylori IgG antibodies
Stool tests

63
Q

How would you treat H. pylori infection?

A

PPI plus metronidazole and clarithromycin; or
PPI plus amoxicillin and clarithromycin
(all twice daily for a week)

64
Q

How should you investigate a patient over 60 years with ulcer-type symptoms and why?

A

Endoscopy

To rule out gastric cancer

65
Q

In an acute upper GI bleed what is your first choice of investigation?

A

Endoscopy

66
Q

In a lower GI bleed what investigations could you do to determine the site of bleeding?

A 
Rectal examination
Proctoscopy
Sigmoidoscopy
Barium enema
Colonoscopy
Angiography
67
Q

What is Meckel’s diverticulum?

A

Congenital abnormality where a diverticulum projects from the wall of the ileum

68
Q

What is Crohn’s disease characterised by?

A

Skip lesions
Affect whole thickness of bowel wall
Granulomatous nature

69
Q

What is characteristic of Ulcerative colitis?

A

Only mucosal layer affected of rectum +/- colon
Continuous distribution
Non-granulomatous nature

70
Q

What produces the cobblestone appearance in CD?

A

Deep ulcers and fissures in mucosa

71
Q

What are risk factors for CD?

A

Genetics
Diet
Smoking
Female

72
Q

What is a protective factor for UC?

A

Smoking

73
Q

What is the immune response mediated by in CD?

A

Th1 cells and macrophages (cell mediated immunity)

74
Q

What is the immune response mediated by in UC?

A

Th2 and B cells (humoral immunity)

75
Q

What part of the GIT is most commonly affected in CD?

A

Terminal ileum

76
Q

What investigations would you do for suspected CD?

A

Bloods (FBC, Inflammatory markers, Antibody serology)
Barium follow through
Colonoscopy

77
Q

How would you investigate a suspected UC?

A 
Stool examination (microbiology)
Bloods (FBC, Inflammatory markers, U&Es, LFTs)
Abdo X-ray
Endoscopy (colonoscopy)
78
Q

What are the possible complications of UC?

A

Primary sclerosing cholangitis
Bowel cancer
Toxic megacolon

79
Q

What is first line short term drug treatment for IBD?

A

Glucoorticoids - Prednisolone

80
Q

What medication is used to maintain remission in IBD?

A

5-ASA drugs - e.g. mesalazine, olsazine

81
Q

What immunosuppressant can be used for treatment of UC?

A

Ciclosporin

82
Q

What immunosuppressant can be used for treatment in CD?

A

Methotrexate

83
Q

What would severe pain occurring after meals, with less frequent relief by antacids or food be indicative of?

A

Gastric ulcer

84
Q

What would epigastric discomfort, with pain radiating to the back, 2-5 hours after eating or when hungry, with burning and hunger-like pains be a sign of?

A

Duodenal ulcer

85
Q

What is the most common functional bowel disorder?

A

Irritable bowel syndrome

86
Q

What are some symptoms of IBS?

A

Nausea and vomiting
Bowel urgency
Abdo pain and bloating
Mucus in stool

87
Q

What does the Rome III diagnostic criteria state a patient must have to be diagnosed with IBS?

A

In preceding 3 months, at least 3 days per month of recurrent abdo pain or discomfort, associated with at least 2 of following:
Improvement with defecation
Onset associated with change in frequency in stool
Onset associated with change in form of stool

88
Q

What are the main three subtypes of IBS?

A

IBS with constipation
IBS with diarrhoea
Mixed IBS

89
Q

Which are the most common subtypes of IBS?

A

IBS with constipation or mixed IBS

90
Q

What are the three classified subgroups of constipation with a normal colon diameter?

A

Normal transit constipation
Slow transit constipation
Disordered defecation

91
Q

What symptoms are associated with slow transit constipation?

A

Bloating
Abdo pain
Infrequent urge to defecate

92
Q

In which patient is slow transit constipation most common?

A

Young women, with symptoms dating back to childhood

93
Q

What is disordered defecation usually due to?

A 
Rectal redundancy caused by:
Pelvic floor dysfunction
Anal sphincter dysfunction
Structural abnormality (eg rectocele)
94
Q

What is severe constipation with gut dilatation normally secondary to?

A

Neuromuscular disorder of the colon:
Hirschsprung’s disease
Idiopathic mega colon
Chronic intestinal pseudo-obstruction

95
Q

What is Hirschsprung’s disease?

A

Congenital anganglionosis of colon, resulting in absence of anorectal reflexes

96
Q

What are the main complications of idiopathic megarectum/megacolon?

A

Faecal impaction

Overflow incontinence

97
Q

How are the findings on an abdominal contrast study different between Hirschsprung’s disease and idiopathic megarectum?

A

Hirschsprung’s - colon proximal to narrowing is dilated

Megarectum - colon distal to narrowing shows continuous dilatation until point of narrowing

98
Q

In presence of constipation what diagnosis would anaemia suggest?

A

Colon cancer

99
Q

What does an evacuation proctography show?

A

Anorectal morphology
Functional abnormalities - eg incoordination of pelvic floor and anal sphincters
Structural abnormalities - eg intussusception, rectal prolapse or rectocele

100
Q

What is a useful method of measuring motor function of the whole gut?

A

Radio-opaque marker study of whole gut transit

101
Q

What diagnosis does the presence of a recto-anal inhibitory reflex exclude?

A

Hirschsprung’s disease

102
Q

What might an ano-rectal sensory test show?

A

Loss of rectal sensation, seen in MS and Parkinson’s

103
Q

What diet advice is given to patients with constipation?

A

Increased fibre intake

Increased liquid intake

104
Q

Name some stimulant laxatives and when would they be used?

A 
Senna or bisacodyl
As required (to prevent laxative dependence)
105
Q

What are some osmotic laxative agents and when are they used?

A

Magnesium salts and lactulose

Effective in slow transit constipation

106
Q

How do bulk-forming laxatives work?

A

Retain fluid within stool, increasing faecal mass
Stimulate peristalsis
Stool-softening properties

107
Q

What is the order of treatment for short duration constipation in adults?

A

1st line - bulk forming laxative
2nd - add/switch to osmotic laxative
3rd - if stools are soft, but still finds difficult to pass, add stimulant laxative

108
Q

What is in probiotics used for treating IBS?

A

Bifidobacterium

109
Q

What is prucalopride?

A

Selective serotonin receptor agonist, acting on serotonin releasing enteroendocrine cells

110
Q

What are antispasmodics used in chronic constipation?

A

Anticholinergic agents
Antimuscarinic agents
Peppermint oil

111
Q

What can be used for pain management in chronic constipation?

A

Antidepressants, eg fluoxetine, paroxetine, citalopram

112
Q

What are the surgical options for constipation caused by dysmotility?

A

Colectomy
Ileorectal anastomosis
Sacral nerve stimulation
Antegrade colonic enema

113
Q

What does sacral nerve stimulation involve?

A

Implantation of programmable stimulator subcutaneously, which delivers low amplitude electrical stimulation via a lead to sacral nerve

114
Q

What does the antegrade colonic enema (ACE) procedure involve?

A

Surgical creation of stoma, which functions as irrigation port to introduce fluid to wash out colon at regular intervals

115
Q

What are surgical indications for treatment of obstructed defecation syndrome?

A

External prolapse
Rectocele
Internal intussusception

Medicine (19 decks)

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