Gastroenterology Flashcards
What is ulcerative colitis?
Inflammation of ulceration of the inner lining of the colon and rectum.
Describe the ulcers found in UC
Continuous
Only affect gut lining
Give 4 symptoms of UC
Diarrhea (blood and mucus) Cramping abdo pain Fatigue Feeling unwell Loss of appetite Weight loss Bloating Tenesmus (feeling like needing to empty bowels but nothing present)
Give 5 potential complications of UC
Strictures, perforation, toxic megacolon, arthritis, erythema nodosum, episcleritis, osteoporosis, higher risk of DVT, anaemia, colorectal cancer.
How is UC managed?
Analgesia Loperamide (reduce diarrhoea) 5-ASAs (Mesalamine, Sulphasalazine) Corticosteroids Immunosuppressants (Azathioprine, Methotrexate, Ciclosporin) Biological drugs (Infliximab) Colectomy with ileostomy
What sign is seen on an abdo x-ray of a UC patient?
Lead pipe colon
What is Crohn’s disease?
Inflammation along the entire GI tract.
Describe the ulcers found in Crohn’s disease
Can be found anywhere in the GI tract (skip lesions)
Transmural (through entire gut wall)
Where does Crohn’s affect first?
Terminal ileum
Give 4 symptoms of Crohn’s
Abdominal pain, fatigue, diarrhoea, mouth ulcers, loss of appetite, weight loss
Give 4 potential complications of Crohn’s
Strictures, perforation, fistulas, arthritis, erythema nodosum, episcleritis, scleritis, uveitis, osteoporosis, kidney stones, gallstones, DVT, anaemia, B12 deficiency, bowel cancer
How is Crohn’s managed?
Paracetamol Loperamide (reduce diarrhoea) 5-ASAs (Mesalamine, Sulphasalazine) Corticosteroids Immunosuppressants (Azathioprine, Methotrexate, Ciclosporin) Biological drugs (Infliximab) Antibiotics Surgical fixing of strictures and fistulas Bowel resection
What is IBS?
Common, long-term condition causing GI symptoms like IBD but there is no obvious pathology.
What are the symptoms of IBS?
Abdominal pain relieved on defecation, diarrhoea, constipation, bloating, flatulence, lethargy, backache, bladder problems, incontinence
Give 4 common triggers for IBS symptoms
Alcohol, fizzy drinks, chocolate, tea, coffee, crisps, biscuits, fatty foods, stress
How is IBS treated?
Avoid trigger foods, alter fiber intake, exercise, reduce alcohol, reduce stress, drink more water
What is coeliac disease?
An autoimmune reaction to gluten causing damage to the lining of the small intestine.
Describe the changes which occur in the bowel in coeliac disease
Flattened villi
Villi merge or disappear
Give 4 risk factors for coeliac disease
Family history Thyroid disease Down's syndrome Turner syndrome Type I diabetes
Give 5 symptoms of coeliac disease
Bloating, diarrhoea, nausea, flatulence, constipation, tiredness, mouth ulcers, unexpected weight loss, hair loss
What is dermatitis herpetiformis?
Rash associated with coeliac disease which appears on the elbows, knees, shoulders, buttocks and face in a symmetrical pattern. It is red, raised and itchy.
Which antibody is tested for in coeliac disease?
IgA tissue transglutaminase antibody
Which classification system is used in Coeliac disease?
Marsh classification
What are the stages of the Marsh classification for coeliac disease?
Stage 0: normal mucosa
Stage 1: increased number of intraepithelial lymphocytes
Stage 2: proliferation of the crypts of Lieberkuhn
Stage 3: Villous atrophy
Stage 4: hypoplasia of the small bowel architecture
What is the treatment for coeliac disease?
Gluten free diet for life
Give 4 potential complications of coeliac disease
Osteoporosis
Lactose intolerance
Lymphoma
Small bowel cancer
What is pancreatitis?
Inflammation of the pancreas
Give 5 causes of acute pancreatitis
GET SMASHED Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion bite Hyperlipidaemia ERCP Drugs
Which drugs can cause pancreatitis?
Azathioprine Thiazide Sulfasalazine Trimethoprim Tetracycline
Give 4 symptoms of acute pancreatitis
Severe, dull epigastric pain worse on eating or drinking and radiating to the back Nausea Diarrhoea Indigestion Fever Jaundice
Which criteria are included in the Glascow score for pancreatitis?
PaO2 (<8kPa) Age (>55yrs) Neutrophils (>15x10-9/L) Calcium (<2 mmol/L) Renal function (urea >16 mmol/L) Enzymes (LDH >600iU/L or AST >2000iU/L) Albumin (<32g/L) Sugar (glucose >10 mmol/L)
How is acute pancreatitis treated?
Fluids
Oxygen
Painkillers
Treat underlying cause
Give 4 potential complications of pancreatitis
Pseudocysts
Infected pancreatic necrosis –> high levels of inflammation restrict blood flow to the pancreas which causes necrosis. The necrotic tissue is then more at risk of infection
Sepsis
Chronic pancreatitis
What is chronic pancreatitis?
Long-term inflammation of the pancreas
Give 4 symptoms of chronic pancreatitis
Abdominal pain which radiates to the back Greasy, foul-smelling stools Nausea and vomiting Weight loss Loss of appetite Jaundice Symptoms of diabetes
Give 3 causes of chronic pancreatitis
Alcoholism Autoimmune Trauma Smoking Radiotherapy side effect
How is chronic pancreatitis treated?
Avoid alcohol Stop smoking Low fat diet Enzyme supplements Corticosteroids Pain relief Pancreas resection or total pancreatectomy
Give 4 risk factors for developing pancreatic cancer
Smoking Alcohol Previous cancer Diet Previous radiotherapy Obesity
Gve 4 causes of pancreatic cancer
Chronic pancreatitis Stomach ulcers Diabetes H.pylori infection Hepatitis
Give 4 symptoms of pancreatic cancer
Dull epigastric pain radiating to the back, pain worse when lying down, jaundice, weight loss, symptoms of diabetes, itching, nausea, vomiting, steatorrhoea, fever, indigestion
What is a Whipple’s procedure?
Removal of the head of the pancreas, duodenum, gallbladder, bile duct and stomach
What is a carcinoid tumour?
A group of tumours which all have an enterochromaffin cell origin and so can produce 5-HT.
Where are carcinoid tumours commonly found?
Appendix, ileum, rectum, ovaries, testes, bronchi
What things can carcinoid tumours secrete?
Bradykinin, tachykinin, substance P, gastrin, insulin, glucagon, ACTH, PTH, thyroid hormones
Give 3 complications of carcinoid tumours
Appendicitis
Bowel obstruction
Carcinoid syndrome (effects of the hormones)
Carcinoid crisis
What is non-alcoholic fatty liver disease?
Fat accumulation around the liver not associated with excessive alcohol intake.
Give 4 causes of non-alcoholic fatty liver disease
Obesity, poor diet, lack of exercise, smoking, type II diabetes, hypertension, hypercholesterolaemia, polycystic ovaries, hepatitis B and C, metabolic syndrome
Give 4 symptoms of non-alcoholic fatty liver disease
Jaundice, easy bruising, dark urine, ascites, haematemesis, melena, encephalopathy, pruritis
What tests can be done to diagnose non-alcoholic fatty liver disease?
LFTs (ALT>AST)
Ultrasound of liver
ELF blood test (hyaluronic acid, procollagen II, tissue inhibitor of metalloproteinase 1)
How is non-alcoholic fatty liver disease treated?
Reduce weight, exercise, control blood pressure, cholesterol and diabetes
Give 4 causes of liver failure
Viral hepatitis Paracetamol overdose Alcohol excess PBC PSC Autoimmune hepatitis Alpha-1-antitrypsin deficiency Wilson's disease Hereditary haemochromatosis
Give 2 signs of liver failure
Jaundice
Ascites
Encephalopathy
Pear drop smell on the breath
What investigations would be done for liver failure?
FBC, U&Es, LFTs, Clotting, Glucose, Paracetamol level, Blood culture, Urine dip, Chest + abdo x-ray, USS
How is liver failure treated?
IV fluid, treat the cause, avoid drugs with liver metabolism, liver transplant
Give 4 complications of liver failure
Cerebral oedema, ascites, bleeding, infection, hypoglycaemia, encephalopathy
What type of virus is hepatitis A?
RNA
What are the symptoms of hepatitis A?
Fever, malaise, anorexia, arthralgia, nausea, jaundice, hepatomegaly, splenomegaly
How is hepatitis A spread?
Fecal oral
Shellfish
How is hepatitis A treated?
Self-limiting
Treat symptoms
Which patients are at high risk of hepatitis B?
IV drug users, health workers, MSM, haemophiliacs, hemodialysis, prison staff, babies with infected mothers.
How can hepatitis B be transmitted?
Contaminated blood products
Sexually
Sharing needles (IVDU)
What are the symptoms and signs of hepatitis B?
Fever, malaise, anorexia, nausea, jaundice, hepatomegaly, splenomegaly, adenopathy
Which antigen is present when a hepatitis B patient is infectious?
HBsAG (surface antigen)
Which antibody will persist for life after hepatitis B exposure?
Anti-HBc
Which antibody would suggest recovery, immunity or successful vaccination against hepatitis B?
Anti-HBs
What does the presence of the HBeAg mean in a hepatitis infection?
Virus is replicating so there are high levels of the hepatitis B virus
What does the presence of anti-HBe mean in a hepatitis infection?
Long-term clearance after antiviral therapy
Give 3 potential complications of a hepatitis B infection
Hepatocellular carcinoma
Fulminant liver failure
Cirrhosis
How is hepatitis C spread?
Blood transfusion, IVDU, sexual contact
What is autoimmune hepatitis?
Production of autoimmune antibodies against hepatocyte surface antigens.
Which conditions are strongly associated with autoimmune hepatitis?
Thyroid disease RA UC Type 1 diabetes Hypergammaglobulinemia
Give 5 symptoms of autoimmune hepatitis
Fatigue, malaise, joint pains, anorexia, nausea, vomiting, itching, rash, excessive hair growth, diarrhoea, amenorrhoea, bloating, oedema, ascites, confusion, jaundice, bruising, dark urine, pale stools
What might be seen on a liver biopsy of a patient with autoimmune hepatitis?
Inflammation
Bridging necrosis
Which antibody will be positive in autoimmune hepatitis:?
Anti-smooth muscle antibody (ASMA)
ANA negative
How is autoimmune hepatitis treated?
Prednisolone
Azathioprine (keeps patient in remission)
Liver transplant
What is the main bacterial cause of a pyogenic liver abscess in children?
Staphylococcus aureus
What is the main bacterial cause of a pyogenic liver abscess in adults?
E. coli
How is a pyogenic liver abscess treated?
Amoxicillin, ciprofloxacin, metroniadazole
What is liver cirrhosis?
Chronic scarring of the liver which prevents it from functioning normally.
Give 5 symptoms of liver cirrhosis
Fatigue, nausea, loss of appetite, loss of sex drive, jaundice, haematemesis, itchy skin, melaena, bruising, oedema, ascites
Give 5 signs of liver cirrhosis
Leukonychia, clubbing, palmar erythema, spider naevi, gynaecomastia, loss of body hair
Give 3 causes of liver cirrhosis
Alcohol excess
Hepatitis
Fatty liver disease
How is liver cirrhosis diagnosed?
Transient elastography LFTs Ultrasound Liver biopsy CT/MRI Endoscopy to check for varices Check alpha fetoprotein for signs of HCC every 6 months
How is liver cirrhosis treated?
Stop drinking alcohol Lose weight Treat any treatable cause Cholestyramine (treats itching) Interferon-alpha Spironolactone Liver transplant
Which criteria are included in the Child-Pugh criteria for a liver transplant?
Serum bilirubin Serum albumin Presence of ascites Encephalopathy INR
What is the main type of primary liver cancer?
Hepatocellular carcinoma
What is cholangiocarcinoma?
Cancer of the bile ducts inside the liver
Give 4 symptoms of primary liver cancer
weight loss, ascites, jaundice, loss of appetite, nausea, vomiting, itching, fever
How is liver cancer diagnosed?
LFTs, FBC, U&Es, alpha fetoprotein, ultrasound, CT, MRI, biopsy, laparoscopy
How is a stage 1 liver cancer treated?
Surgery
Liver transplant
Radiofrequency ablation
How is a stage 4 liver cancer treated?
Biological therapy
Chemotherapy
Treat symptoms
Palliative care
What is primary biliary cholangitis?
The intralobular ducts in the liver are damaged by chronic autoimmune granulomatous inflammation which leads to fibrosis, cirrhosis and portal hypertension.
What antibody is present in PBC patients?
Antimicrobial antibodies
Give 4 signs of PBC
Jaundice Skin pigmentation Xanthelasma Xanthomata Hepatosplenomegaly
Give 4 symptoms of PBC
Bone and joint aches, fatigue, itchy skin, dry eyes, dry mouth, RUQ pain
Give 4 potential complications of PBC
Cirrhosis Osteoporosis Malabsorption of vitamins A, D, E, K Osteomalacia Coagulopathy Portal hypertension Ascites
How is PBC diagnosed?
LFTs, bilirubin, albumin, clotting, immunoglobulins, cholesterol, ultrasound
What is the M rule in regards to PBC?
IgM
Anti-Mitochondrial antibodies, M2 subtype
Middle aged females
What other conditions is PBC strongly linked to?
RA
SLE
Thyroid disease
Sjogren’s syndrome
How is PBC managed?
Avoid NSAIDs Ursodeoxycholic acid Obeticholic acid Cholestyramine Vitamin A, D, E, K supplements Rifampicin and naltrexone to reduce itching Liver transplant
What is primary sclerosing cholangitis?
Bile ducts progressively decrease in size due to inflammation and fibrosis. The bile accumulates in the liver and causes liver cirrhosis
Give 3 symptoms of PSC
Tiredness RUQ pain Itching Jaundice Fever with chills
Give 3 complications of PSC
Liver failure Bile duct cancer Bowel cancer Liver cancer Gallbladder cancer
How is PSC diagnosed?
Cholangiogram, liver biopsy, LFTS, bilirubin, albumin
How is PSC treated?
Ursodeoxycholic acid Cholestyramine Rifampicin Naltrexone Vitamin A, D, E, K supplements Liver transplant
What is Wilson’s disease?
Excess copper in the body due to a genetic defect in metabolising copper
What are the symptoms of Wilson’s disease?
Jaundice, abdominal pain, ascites, haematemesis, clumsiness, loss of muscle control, contractions, bradykinesia, slurred voice, dysphagia, personality change, anxiety, delusions
Give a common sign of Wilson’s disease
Brown ring around the cornea of the eye (Kayser-Fleischer ring)
How is Wilson’s disease treated?
Remove copper from diet
D-penicillamine (removes copper from the body)
Liver transplant
How is hereditary hemochromatosis inherited?
Autosomal recessive
What is hereditary haemochromatosis?
Excessive iron accumulation in the body due to a gene abnormality which increases the amount of iron absorbed from the gut.
Give 4 symptoms and signs of hereditary haemochromatosis
Fatigue, limb weakness, joint pain, stomach pain, loss of sex drive, impotence, cardiomyopathy, jaundice, confusion, mood swings, depression, bronze skin, hypogonadism, arthritis, liver cirrhosis
How is hereditary hemochromatosis diagnosed?
Transferrin saturation Serum ferritin Genetic screening LFTs Liver biopsy
How is hereditary hemochromatosis treated?
Phlebotomy- regular bleeding to remove excess iron
Liver transplant
Reduce dietary iron
