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Progress > gastroenterology > Flashcards

gastroenterology Flashcards

1
Q

ulcerative colitis on barium enema

A 
colon has irregular mucosa
loss of haustral markings
continuous - no skip lesions
pseudopolyps
longstanding disease - drainpipe colon - colon narrow + short
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2
Q

where is inflammation in UC?

A

starts at rectum (commonest site)

never spreads beyond ileocaecal valve

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3
Q

initial presentation of UC

A 
insidious + intermittent
bloody diarrhoea
urgency
tenesmus
LLQ pain
extra-intestinal features
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4
Q

peak incidence of UC (age)

A

15-25

55-65

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5
Q

extra-intestinal features of IBD

A

arthritis - esp sacroiliitis in UC
episcleritis
osteoporosis
clubbing

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6
Q

what type of oesophageal cancer is associated with GORD + barrett’s?

A

adenocarcinoma (commonest type of OC)

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7
Q

where in the oesophagus are tumours most likely to lie?

A

middle 1/3

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8
Q

diagnosis + staging of oesophageal cancer

A

upper GI endoscopy
staging - CT TAP
if CT doesn’t show mets - endoscopic USS

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9
Q

management of oesophageal cancer

A

surgical removal + adjuvant chemo

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10
Q

risk of surgery for oesophageal cancer

A

anastomotic leak - can cause mediastinitis

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11
Q

chrons - where affected + whats it like?

A

mouth-anus - terminal ileum + colon most affected

skip lesions

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12
Q

what acute complication can occur in UC?

A

toxic megacolon

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13
Q

what acute complication can occur in chron’s?

A

caecal volvulus

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14
Q

what are the RFs for caecal volvulus in chron’s?

A

adhesions secondary to chron’s

previous surgery

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15
Q

how does volvulus present + show on xray?

A

abdo pain + distension
constipation
N/V

large dilated loop of bowel

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16
Q

what are 3 associations of sigmoid volvulus?

A

chronic constipation
neuro or psych conditions
old age

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17
Q

2 associations of caecal volvulus

A

adhesions
pregnancy

(all ages)

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18
Q

how does sigmoid volvulus look on xray?

A

LBO: large dilated loop of colon
air + fluid levels
coffee bean sign

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19
Q

how does caecal volvulus look on xray?

A

small bowel obstruction

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20
Q

management of sigmoid volvulus

A

rigid sigmoidoscopy + rectal tube insertion

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21
Q

management of caecal volvulus

A

operative - right hemicolectomy often

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22
Q

classic appearance of chron’s on barium enema

A

kantor’s string sign: long segment of narrowed terminal ileum in string-like configuration - ie a long stricture
proximal bowel dilation
rose thorn ulcers + fistulae

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23
Q

what’s a marker of activity in chron’s?

A

CRP

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24
Q

how do you diagnose bowel perforation?

A

erect CXR - pneumoperitoneum - air under the diaphragm

CT now preferred

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25
Q

what do positive anti-endomysial antibodies indicate?

A

coeliac

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26
Q

how to manage a patient with dysphagia (GP)

A

urgent referral

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27
Q

age 55+ with weight loss and:

upper abdo pain / reflux / dyspepsia

A

urgent referral

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28
Q

management of general dyspepsia

A

trial of full dose PPI for 1mo

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29
Q

diagnosis of h pylori

A

carbon-13 urea breath test or stool antigen test

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30
Q

h pylori - test of cure

A

carbon-13 urea breath test

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31
Q

jejunal biopsy shows villous atrophy, raised intra-epithelial lymphocytes + crypt hyperplasia - what is it?

A

coeliac: repeated gluten exposure → villous atrophy → malabsorption (reverses on gluten elimination)

(cancer would be dysplasia)

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32
Q

c diff - 1st line treatment

A

oral metronidazole 10-14 days

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33
Q

giardia lamblia - what medication treats?

A

giardia lamblia

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34
Q

coeliac - diagnosis

A

immunology (TTG, endomyseal antibody) + jejunal biopsy

reintroduce gluten for at least 6wk prior to testing

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35
Q

diagnosis of coeliac - immunology

A 
TTG (IgA) - 1st choice
endomyseal antibody (IgA)
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36
Q

what is achalasia?

A

lack of relaxation of LOS on swallowing

37
Q

achalasia - investigations when scope normal

A

assess oesophageal motility:
fluoroscopic barium swallow
oesophageal manometry - pressures usually high
pH studies

38
Q

pain on swallowing (odynophagia) + hx heartburn (no weight loss, systemically well)?

A

oesophagitis

39
Q

achalasia pattern + symptoms

A

dysphagia of liquids + solids from the start
heartburn
regurgitation → cough, asp pneumonia

40
Q

systemic sclerosis - how does it affect GI system?

A

oesophageal dysmotility

LOS pressure decreased

41
Q

associated symptoms of IBS

A

lethargy
nausea
backache
bladder symptoms

42
Q

IBS symptoms in someone over 60 - significance?

A

red flag

43
Q

bowel obstruction + fistulae - what kind of IBD?

A

chron’s

44
Q

goblet cells + granulomas - what kind of IBD?

A

chron’s

45
Q

abdo mass in RIF - what kind of IBD?

A

chron’s

46
Q

chron’s - histology

A

inflammation in all layers from mucosa to serosa - more prone to strictures, fistulas + adhesions
goblet cells
granulomas

think - chrons everywhere - mouth to anus, down to serosa

47
Q

UC - histology

A 
no inflammation beyond submucosa
inflammatory cell infiltrate in lamina propria
crypt abscesses
depleted goblet cells + mucin
granulomas infrequent
48
Q

deep ulcers + cobble-stone appearance on scope?

A

chron’s

49
Q

widespread ulceration + pseudopolyps om scope?

A

UC

50
Q

where does diverticulosis most commonly occur?

A

sigmoid colon

51
Q

diverticulitis - presentation

A

LIF pain + tenderness
anorexia, N+V, diarrhoea
features of infection

52
Q

management of diverticulitis

A

mild - oral abx

severe - admit, NBM, IV fluids + abx (a cephalosporin + metronidazole)

53
Q

diverticulitis - complications

A

abscess
peritonitis
obstruction
perforation

54
Q

oesophageal cancer - gold standard investigation

A

endoscopy

55
Q

toxic megacolon - mgmt

A

aggressive medical therapy 24-72h

no improvement - colectomy

56
Q

what is clindamycin associated with (adverse)?

A

c diff

57
Q

complication of c diff

A

toxic megacolon

58
Q

c diff - diagnosis

A

c diff toxin on stool test

59
Q

3 causes of bowel ischaemia

A

AF
endocarditis
malignancy
cocaine

60
Q

bowel ischaemia - features

A 
abdo pain
rectal bleeding
diarrhoea
fever
high WCC + lactic acidosis
61
Q

bowel ischaemia - diagnosis

A

CT

62
Q

oesophageal variceal haemorrhage - mgmt (after resus)

A 
correct clotting - FFP, vit K
terlipressin
prophylactic IV abx if liver cirrhosis
endoscopic variceal band ligation
SB tube → TIPSS if all fail
63
Q

prophylaxis of variceal haemorrhage

A

propanolol

endoscopic variceal band ligation + PPI (2-weekly)

64
Q

coeliac - presentation (kids + adults)

A

kids - failure to thrive, diarrhoea, abdo distension

adults - lethargy, anaemia, diarrhoea, weight loss, poss other AI conditions

65
Q

factors used to classify liver cirrhosis (MELD)

A

bilirubin
creatinine
INR

66
Q

what does reduced serum caeruloplasmin indicate?

A

wilson’s

caeruloplasmin carries 95% of plasma copper

67
Q

wilson’s - initial presentation

A

age 10-25
kids - liver disease
adults - neuro disease

68
Q

wilson’s - diagnosis

A

reduced serum caeruloplasmin
reduced serum copper
increased 24h urinary copper excretion

69
Q

wilson’s - mgmt

A

penicillamine (chelates copper)

70
Q

staging of gastric cancer

A

endoscopic USS or CT
laparoscopy to identify peritoneal disease
PET CT

71
Q

gastric cancer - mgmt

A

partial/gastrectomy
lymphadenectomy
chemo

72
Q

Duodenal ulcers on histology

A

Granulation tissue

73
Q

SBO - investigations + management

A

AXR + erect CXR
IV fluids
sucking via NG tube

CT + surgery if no improve

74
Q

SBO - what seen on AXR?

A

dilated bowel loops

75
Q

SBO - what seen on erect CXR?

A

pneumoperitoneum

76
Q

small bowel on AXR

A

valvulae extend all way across

77
Q

large bowel on AXR

A

haustra extend 1/3 way across

78
Q

coeliac disease - link to immunisations?

A

functional hyposplenism - have pneumococcal vaccine

79
Q

what is the modified hartmann’s procedure?

A

mainly for carcinoma w acute obstruction
primary resection w delayed anastomosis
excise lesion, create colostomy + cross-staple rectal stump
can have restorative anastomosis at later date

80
Q

what scar does a hartmann’s leave?

A

emergency laparotomy scar - midline abdo (confirm this and get name)

81
Q

what is an abdominoperineal resection? what is the main indication?

A

rectal carcinoma in the distal 1/3 of the rectum

removal of the anus, rectum, part of sigmoid + regional LNs
incisions made in abdo + perineum
end of remaining sigmoid is brought out permanently as a colostomy

82
Q

how can you tell if a stoma is the result of an emergency hartmann’s or an AP resection?

A

need to palpate anus + inspect perineal area

in an APR, pt has imperforate anus - can’t do DRE

83
Q

indications for an anterior resection vs AP resection

A

tumours in upper and middle ⅓ of rectum

lower ⅓ rectum

84
Q

how do fistulae form in chron’s?

A

chron’s inflammation can go all way through bowel wall, creating fistulae from erosion - entero-enteric fistulae

85
Q

what does an apple core sign suggest?

A

infiltrating carcinoma in bowel wall causing stricture

86
Q

signet ring histology - significance

A

gastric cancer

87
Q

gastric cancer - presentation - symptoms + OE

A

epigastric fullness/pain
anorexia + weight loss
vomiting
anaemia

cachexia
hepatomegaly
virchow’s node

88
Q

gastric cancer - investigations

A

endoscopy + biopsy
Ba meal
CT - local spread

89
Q

gastic cancer - mgmt

A

partial gastrectomy; or gastroenterostomy
radical gastrectomy if v early polypoid lesion (eg incidental finding)
chemo + radio of little benefit

Progress (20 decks)

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