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Human Disease Y3 > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

what is dysphagia ?

A

difficulty swallowing as a symptom of disease

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2
Q

what structural abnormalities are associated with dysphagia ?

A 
pharyngeal pouch,
oesophagitis - reflux and infective,
benign strictures,
malignant strictures,
extrinsic pressure - goitre, AA, lung Ca, lymph nodes
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3
Q

what motility problems are associated with dysphagia ?

A 
achalasia,
oesophageal spasm,
bulbar palsy,
pseudobulbar palsy,
systemic sclerosis,
Chagas disease
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4
Q

what is achalasia ?

A

the muscles of the lower part of the oesophagus fail to relax, preventing food from entering the stomach

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5
Q

what are the symptoms of gastro oesophageal reflux disease ?

A 
heartburn,
odynophagia,
waterbrash (excessive salivation),
acid brash (acid/bile regurgitation),
belching
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6
Q

what is GORD?

A

dysfunction of the lower oesophageal sphincter predisposing to the reflux of acid into the oesophagus

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7
Q

what is GORD associated with ?

A 
pregnancy,
obesity,
alcohol,
smoking,
hiatus hernia,
helicobacter pylori,
anticholinergic medications
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8
Q

what is the management of GORD ?

A

lifestyle measures - weight loss, smoking and alcohol cessation, small meals
medication - OTC antacids eg gaviscon, PRI’s eg omeprazole, lansoprazole, H2 antagonists eg ranitidine
endoscopy

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9
Q

what are the complications of GORD ?

A

benign strictures, Barrett’s oesophagus, oesophageal carcinoma

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10
Q

what is Barrett’s oesophagus ?

A

metaplastic change of the distal oesophageal epithelium from squamous to columnar type,
upwards migration of the squamocolumnar junction,
increased risk of adenocarcinoma

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11
Q

how is Barrett’s oesophagus managed ?

A

yearly endoscopic surveillance and biopsy,

if dysplastic changes are found the affected tissue is removed by oesophageal resection or mucosal ablation

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12
Q

what is peptic ulcer disease ?

A

peptic or stomach ulcer, break in the lining of the stomach, ulcer in stomach = gastric ulcer, ulcer in intestine = duodenal ulcer

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13
Q

where do gastric ulcers most commonly occur ?

A

lesser curve of the stomach

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14
Q

what are the symptoms of PUD ?

A

epigastric pain after (GU) or before (DU) meals, relief with antacids,
heartburn,
postprandial epigastric discomfort and fullness, belching, early satiety, nausea

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15
Q

what are the causes of PUD ?

A

infection by helicobacter pylori,
drugs e.g. NSAIDs, steroids, bisphosphonates,
hormonal - Zollinger-Ellinson syndrome,
associated with alcohol, smoking, stress, blood group O

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16
Q

what is the pathogenesis of helicobacter pylori in PUD ?

A

increased gastric acid secretion,
gastric metaplasia,
immune response,
mucosal defence mechanisms

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17
Q

what are the alarm symptoms of PUD ?

A 
anaemia, 
loss of weight,
anorexia,
recent onset, progressive symptoms, 
melaena or haematemesis,
swallowing difficulty
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18
Q

how is PUD investigated ?

A

endoscopy,

H. Pylori detection (breath test, stool antigen, serology, biopsy)

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19
Q

what is the treatment for PUD?

A 
lifestyle adjustment, 
cessation of causative medication,
H. pylori eradication,
PPI's,
H2 receptor antagonists
20
Q

how are upper GI bleeds managed ?

A

airway,
breathing,
circulation - 2 large bore cannulae, IV fluid resus, blood transfusion, correct clotting abnormalities with vitamin K and FFP,
urgent endocopy,
administer IV terlipressin and antibiotics and consider surgical banding or sclerotherapy via ODG if known varices,
adrenaline injection, diathermy, laser coagulation,
sengstaken - Blakemore tubes can be used in uncontrolled bleeding

21
Q

what is haematemesis ?

A

vomiting blood

22
Q

what is malaena ?

A

black stools due to the inclusion of blood

23
Q

what are the causes of upper GI bleeds ?

A 
Mallory Weiss tear,
oesophagitis,
gastritis,
PUD,
GI malignancy,
oesophageal varices,
bleeding disorders, 
angiodysplasia,
drugs - NSAIDs, steroids, anticoagulants, thrombolytics
24
Q

what is coeliac disease ?

A

auto immune condition with inflammation of the proximal small bowel mucosa that improves when the patient maintains a gluten free diet

25
Q

where is gluten found ?

A

wheat, rye, barley, pure oats are not harmful

26
Q

which genes give genetic susceptibility to coeliac disease ?

A

DQ2, DQ8

27
Q

what skin condition is associated with coeliac disease ?

A

dermatitis herpetiformis

28
Q

what are the clinical features of coeliac disease ?

A

diarrhoea/steatorrhoea,
abdominal pain and bloating,
weight loss,
oral ulceration and angular chelitis

29
Q

how is coeliac disease investigated ?

A

endomysial and tissue transglutaminase antibodies,

jejunal/duodenal biopsy

30
Q

what is the treatment for coeliac disease ?

A

gluten free diet

31
Q

what pathology is seen in coeliac disease ?

A

villous atrophy, crypt hyperplasia —> loss of absorption

chronic inflammatory lymphocytic infiltrate within th epithelium

32
Q

what diseases are included in inflammatory bowel disease ?

A

Crohn’s disease

ulcerative collitis

33
Q

what is the aetiology of IBD ?

A

genetic susceptibility CARD15,
environmental factors - smoking linked to CD but protective in UC, high fat and sugar intake, intestinal microflora (anaerobic in CD, aerobic in UC),
host immune response - defects in immunoregulation or barrier function

34
Q

what is ulcerative colitis ?

A

inflammatory bowel disease causing inflammation and ulcers in the colon

35
Q

what are the clinical features of UC

A 
diarrhoea with blood and mucus,
tenesmus,
urgency,
lower abdominal discomfort,
constitutional symptoms eg malaise, lethargy, anorexia, low grade fever,
oral ulceration
36
Q

what parts of the bowel are affected by Crohn’s disease ?

A

any part of the bowel can be affected but most likely terminal ileum and ascending colon

37
Q

what are the clinical features of Crohn’s disease ?

A

abdominal pain,
diarrhoea,
weight loss,
constitutional symptoms - malaise, lethargy, anorexia, low grade fever,
oral lesions - labial swelling, ulceration, angular chelitis, cobblestoning,
perianal lesions - fissures, skin tags, perianal abscesses, anorectal fistulae

38
Q

how is irritable bowel disease investigated ?

A 
blood tests - iron deficiency anaemia, raised CRP/WBC, hypoalbuminaemia,
barium enema,
colonoscopy,
MRI,
biopsy
39
Q

what is the management for Crohn’s disease ?

A 
smoking cessation,
treat diarrhoea and anaemia,
oral corticosteroids,
azathioprine,
biological agents e.g. infliximab,
mycophenalate mofatil 
surgery
40
Q

what is the management for ulcerative colitis ?

A 
aminosalicyclates,
rectal corticosteroid preparations,
oral corticosteroids,
azothiaprine,
surgery
41
Q

what is irritable bowel syndrome ?

A

a functional bowel disorder with no organic cause, likely to be a disorder of intestinal motility or enhanced visceral perception

42
Q

what are the symptoms of IBS ?

A

abdominal bloating,
central/lower abdominal pain relieved by defacation,
PR mucus,
altered bowel habit

43
Q

what is the treatment for IBS?

A

antispasmodics eg mebervine,
treatment of constipation or diarrhoea,
tricyclic antidepressants

44
Q

how is diarrhoea classified ?

A

acute 14 days,

chronic > 3 months

45
Q

what are the common causes of diarrhoea ?

A 
gastroenteritis,
IBS,
IBD,
coeliac disease,
antibiotics, laxatives, PPI's,
colorectal cancer
46
Q

what are uncommon causes of diarrhoea ?

A 
hyperthyroidism,
lactose intolerance,
overflow diarrhoea,
ischemic colitis,
chronic pancreatitis,
addison's disease

Human Disease Y3 (24 decks)

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