Gastroenterology Flashcards
what is dysphagia ?
difficulty swallowing as a symptom of disease
what structural abnormalities are associated with dysphagia ?
pharyngeal pouch, oesophagitis - reflux and infective, benign strictures, malignant strictures, extrinsic pressure - goitre, AA, lung Ca, lymph nodes
what motility problems are associated with dysphagia ?
achalasia, oesophageal spasm, bulbar palsy, pseudobulbar palsy, systemic sclerosis, Chagas disease
what is achalasia ?
the muscles of the lower part of the oesophagus fail to relax, preventing food from entering the stomach
what are the symptoms of gastro oesophageal reflux disease ?
heartburn, odynophagia, waterbrash (excessive salivation), acid brash (acid/bile regurgitation), belching
what is GORD?
dysfunction of the lower oesophageal sphincter predisposing to the reflux of acid into the oesophagus
what is GORD associated with ?
pregnancy, obesity, alcohol, smoking, hiatus hernia, helicobacter pylori, anticholinergic medications
what is the management of GORD ?
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
what are the complications of GORD ?
benign strictures, Barrett’s oesophagus, oesophageal carcinoma
what is Barrett’s oesophagus ?
metaplastic change of the distal oesophageal epithelium from squamous to columnar type,
upwards migration of the squamocolumnar junction,
increased risk of adenocarcinoma
how is Barrett’s oesophagus managed ?
yearly endoscopic surveillance and biopsy,
if dysplastic changes are found the affected tissue is removed by oesophageal resection or mucosal ablation
what is peptic ulcer disease ?
peptic or stomach ulcer, break in the lining of the stomach, ulcer in stomach = gastric ulcer, ulcer in intestine = duodenal ulcer
where do gastric ulcers most commonly occur ?
lesser curve of the stomach
what are the symptoms of PUD ?
epigastric pain after (GU) or before (DU) meals, relief with antacids,
heartburn,
postprandial epigastric discomfort and fullness, belching, early satiety, nausea
what are the causes of PUD ?
infection by helicobacter pylori,
drugs e.g. NSAIDs, steroids, bisphosphonates,
hormonal - Zollinger-Ellinson syndrome,
associated with alcohol, smoking, stress, blood group O
what is the pathogenesis of helicobacter pylori in PUD ?
increased gastric acid secretion,
gastric metaplasia,
immune response,
mucosal defence mechanisms
what are the alarm symptoms of PUD ?
anaemia, loss of weight, anorexia, recent onset, progressive symptoms, melaena or haematemesis, swallowing difficulty
how is PUD investigated ?
endoscopy,
H. Pylori detection (breath test, stool antigen, serology, biopsy)
what is the treatment for PUD?
lifestyle adjustment, cessation of causative medication, H. pylori eradication, PPI's, H2 receptor antagonists
how are upper GI bleeds managed ?
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
what is haematemesis ?
vomiting blood
what is malaena ?
black stools due to the inclusion of blood
what are the causes of upper GI bleeds ?
Mallory Weiss tear, oesophagitis, gastritis, PUD, GI malignancy, oesophageal varices, bleeding disorders, angiodysplasia, drugs - NSAIDs, steroids, anticoagulants, thrombolytics
what is coeliac disease ?
auto immune condition with inflammation of the proximal small bowel mucosa that improves when the patient maintains a gluten free diet
where is gluten found ?
wheat, rye, barley, pure oats are not harmful
which genes give genetic susceptibility to coeliac disease ?
DQ2, DQ8
what skin condition is associated with coeliac disease ?
dermatitis herpetiformis
what are the clinical features of coeliac disease ?
diarrhoea/steatorrhoea,
abdominal pain and bloating,
weight loss,
oral ulceration and angular chelitis
how is coeliac disease investigated ?
endomysial and tissue transglutaminase antibodies,
jejunal/duodenal biopsy
what is the treatment for coeliac disease ?
gluten free diet
what pathology is seen in coeliac disease ?
villous atrophy, crypt hyperplasia —> loss of absorption
chronic inflammatory lymphocytic infiltrate within th epithelium
what diseases are included in inflammatory bowel disease ?
Crohn’s disease
ulcerative collitis
what is the aetiology of IBD ?
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
what is ulcerative colitis ?
inflammatory bowel disease causing inflammation and ulcers in the colon
what are the clinical features of UC
diarrhoea with blood and mucus, tenesmus, urgency, lower abdominal discomfort, constitutional symptoms eg malaise, lethargy, anorexia, low grade fever, oral ulceration
what parts of the bowel are affected by Crohn’s disease ?
any part of the bowel can be affected but most likely terminal ileum and ascending colon
what are the clinical features of Crohn’s disease ?
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
how is irritable bowel disease investigated ?
blood tests - iron deficiency anaemia, raised CRP/WBC, hypoalbuminaemia, barium enema, colonoscopy, MRI, biopsy
what is the management for Crohn’s disease ?
smoking cessation, treat diarrhoea and anaemia, oral corticosteroids, azathioprine, biological agents e.g. infliximab, mycophenalate mofatil surgery
what is the management for ulcerative colitis ?
aminosalicyclates, rectal corticosteroid preparations, oral corticosteroids, azothiaprine, surgery
what is irritable bowel syndrome ?
a functional bowel disorder with no organic cause, likely to be a disorder of intestinal motility or enhanced visceral perception
what are the symptoms of IBS ?
abdominal bloating,
central/lower abdominal pain relieved by defacation,
PR mucus,
altered bowel habit
what is the treatment for IBS?
antispasmodics eg mebervine,
treatment of constipation or diarrhoea,
tricyclic antidepressants
how is diarrhoea classified ?
acute 14 days,
chronic > 3 months
what are the common causes of diarrhoea ?
gastroenteritis, IBS, IBD, coeliac disease, antibiotics, laxatives, PPI's, colorectal cancer
what are uncommon causes of diarrhoea ?
hyperthyroidism, lactose intolerance, overflow diarrhoea, ischemic colitis, chronic pancreatitis, addison's disease
