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Phase 2- Gen Med > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What is ulcerative colitis?

A

Inflammation of ulceration of the inner lining of the colon and rectum.

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2
Q

Describe the ulcers found in UC

A

Continuous

Only affect gut lining

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3
Q

Give 4 symptoms of UC

A 
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)
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4
Q

Give 5 potential complications of UC

A

Strictures, perforation, toxic megacolon, arthritis, erythema nodosum, episcleritis, osteoporosis, higher risk of DVT, anaemia, colorectal cancer.

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5
Q

How is UC managed?

A 
Analgesia
Loperamide (reduce diarrhoea)
5-ASAs (Mesalamine, Sulphasalazine) 
Corticosteroids
Immunosuppressants (Azathioprine, Methotrexate, Ciclosporin)
Biological drugs (Infliximab)
Colectomy with ileostomy
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6
Q

What sign is seen on an abdo x-ray of a UC patient?

A

Lead pipe colon

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7
Q

What is Crohn’s disease?

A

Inflammation along the entire GI tract.

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8
Q

Describe the ulcers found in Crohn’s disease

A

Can be found anywhere in the GI tract (skip lesions)

Transmural (through entire gut wall)

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9
Q

Where does Crohn’s affect first?

A

Terminal ileum

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10
Q

Give 4 symptoms of Crohn’s

A

Abdominal pain, fatigue, diarrhoea, mouth ulcers, loss of appetite, weight loss

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11
Q

Give 4 potential complications of Crohn’s

A

Strictures, perforation, fistulas, arthritis, erythema nodosum, episcleritis, scleritis, uveitis, osteoporosis, kidney stones, gallstones, DVT, anaemia, B12 deficiency, bowel cancer

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12
Q

How is Crohn’s managed?

A 
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
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13
Q

What is IBS?

A

Common, long-term condition causing GI symptoms like IBD but there is no obvious pathology.

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14
Q

What are the symptoms of IBS?

A

Abdominal pain relieved on defecation, diarrhoea, constipation, bloating, flatulence, lethargy, backache, bladder problems, incontinence

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15
Q

Give 4 common triggers for IBS symptoms

A

Alcohol, fizzy drinks, chocolate, tea, coffee, crisps, biscuits, fatty foods, stress

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16
Q

How is IBS treated?

A

Avoid trigger foods, alter fiber intake, exercise, reduce alcohol, reduce stress, drink more water

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17
Q

What is coeliac disease?

A

An autoimmune reaction to gluten causing damage to the lining of the small intestine.

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18
Q

Describe the changes which occur in the bowel in coeliac disease

A

Flattened villi

Villi merge or disappear

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19
Q

Give 4 risk factors for coeliac disease

A 
Family history 
Thyroid disease
Down's syndrome 
Turner syndrome 
Type I diabetes
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20
Q

Give 5 symptoms of coeliac disease

A

Bloating, diarrhoea, nausea, flatulence, constipation, tiredness, mouth ulcers, unexpected weight loss, hair loss

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21
Q

What is dermatitis herpetiformis?

A

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.

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22
Q

Which antibody is tested for in coeliac disease?

A

IgA tissue transglutaminase antibody

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23
Q

Which classification system is used in Coeliac disease?

A

Marsh classification

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24
Q

What are the stages of the Marsh classification for coeliac disease?

A

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

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25
Q

What is the treatment for coeliac disease?

A

Gluten free diet for life

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26
Q

Give 4 potential complications of coeliac disease

A

Osteoporosis
Lactose intolerance
Lymphoma
Small bowel cancer

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27
Q

What is pancreatitis?

A

Inflammation of the pancreas

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28
Q

Give 5 causes of acute pancreatitis

A 
GET SMASHED
Gallstones 
Ethanol 
Trauma
Steroids
Mumps
Autoimmune
Scorpion bite
Hyperlipidaemia 
ERCP
Drugs
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29
Q

Which drugs can cause pancreatitis?

A 
Azathioprine 
Thiazide
Sulfasalazine
Trimethoprim 
Tetracycline
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30
Q

Give 4 symptoms of acute pancreatitis

A 
Severe, dull epigastric pain worse on eating or drinking and radiating to the back 
Nausea
Diarrhoea
Indigestion 
Fever
Jaundice
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31
Q

Which criteria are included in the Glascow score for pancreatitis?

A 
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)
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32
Q

How is acute pancreatitis treated?

A

Fluids
Oxygen
Painkillers
Treat underlying cause

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33
Q

Give 4 potential complications of pancreatitis

A

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

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34
Q

What is chronic pancreatitis?

A

Long-term inflammation of the pancreas

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35
Q

Give 4 symptoms of chronic pancreatitis

A 
Abdominal pain which radiates to the back 
Greasy, foul-smelling stools
Nausea and vomiting 
Weight loss
Loss of appetite
Jaundice
Symptoms of diabetes
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36
Q

Give 3 causes of chronic pancreatitis

A 
Alcoholism 
Autoimmune 
Trauma 
Smoking 
Radiotherapy side effect
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37
Q

How is chronic pancreatitis treated?

A 
Avoid alcohol 
Stop smoking 
Low fat diet 
Enzyme supplements
Corticosteroids
Pain relief
Pancreas resection or total pancreatectomy
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38
Q

Give 4 risk factors for developing pancreatic cancer

A 
Smoking
Alcohol 
Previous cancer
Diet 
Previous radiotherapy 
Obesity
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39
Q

Gve 4 causes of pancreatic cancer

A 
Chronic pancreatitis
Stomach ulcers
Diabetes
H.pylori infection 
Hepatitis
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40
Q

Give 4 symptoms of pancreatic cancer

A

Dull epigastric pain radiating to the back, pain worse when lying down, jaundice, weight loss, symptoms of diabetes, itching, nausea, vomiting, steatorrhoea, fever, indigestion

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41
Q

What is a Whipple’s procedure?

A

Removal of the head of the pancreas, duodenum, gallbladder, bile duct and stomach

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42
Q

What is a carcinoid tumour?

A

A group of tumours which all have an enterochromaffin cell origin and so can produce 5-HT.

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43
Q

Where are carcinoid tumours commonly found?

A

Appendix, ileum, rectum, ovaries, testes, bronchi

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44
Q

What things can carcinoid tumours secrete?

A

Bradykinin, tachykinin, substance P, gastrin, insulin, glucagon, ACTH, PTH, thyroid hormones

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45
Q

Give 3 complications of carcinoid tumours

A

Appendicitis
Bowel obstruction
Carcinoid syndrome (effects of the hormones)
Carcinoid crisis

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46
Q

What is non-alcoholic fatty liver disease?

A

Fat accumulation around the liver not associated with excessive alcohol intake.

47
Q

Give 4 causes of non-alcoholic fatty liver disease

A

Obesity, poor diet, lack of exercise, smoking, type II diabetes, hypertension, hypercholesterolaemia, polycystic ovaries, hepatitis B and C, metabolic syndrome

48
Q

Give 4 symptoms of non-alcoholic fatty liver disease

A

Jaundice, easy bruising, dark urine, ascites, haematemesis, melena, encephalopathy, pruritis

49
Q

What tests can be done to diagnose non-alcoholic fatty liver disease?

A

LFTs (ALT>AST)
Ultrasound of liver
ELF blood test (hyaluronic acid, procollagen II, tissue inhibitor of metalloproteinase 1)

50
Q

How is non-alcoholic fatty liver disease treated?

A

Reduce weight, exercise, control blood pressure, cholesterol and diabetes

51
Q

Give 4 causes of liver failure

A 
Viral hepatitis
Paracetamol overdose
Alcohol excess
PBC
PSC
Autoimmune hepatitis
Alpha-1-antitrypsin deficiency 
Wilson's disease
Hereditary haemochromatosis
52
Q

Give 2 signs of liver failure

A

Jaundice
Ascites
Encephalopathy
Pear drop smell on the breath

53
Q

What investigations would be done for liver failure?

A

FBC, U&Es, LFTs, Clotting, Glucose, Paracetamol level, Blood culture, Urine dip, Chest + abdo x-ray, USS

54
Q

How is liver failure treated?

A

IV fluid, treat the cause, avoid drugs with liver metabolism, liver transplant

55
Q

Give 4 complications of liver failure

A

Cerebral oedema, ascites, bleeding, infection, hypoglycaemia, encephalopathy

56
Q

What type of virus is hepatitis A?

A

RNA

57
Q

What are the symptoms of hepatitis A?

A

Fever, malaise, anorexia, arthralgia, nausea, jaundice, hepatomegaly, splenomegaly

58
Q

How is hepatitis A spread?

A

Fecal oral

Shellfish

59
Q

How is hepatitis A treated?

A

Self-limiting

Treat symptoms

60
Q

Which patients are at high risk of hepatitis B?

A

IV drug users, health workers, MSM, haemophiliacs, hemodialysis, prison staff, babies with infected mothers.

61
Q

How can hepatitis B be transmitted?

A

Contaminated blood products
Sexually
Sharing needles (IVDU)

62
Q

What are the symptoms and signs of hepatitis B?

A

Fever, malaise, anorexia, nausea, jaundice, hepatomegaly, splenomegaly, adenopathy

63
Q

Which antigen is present when a hepatitis B patient is infectious?

A

HBsAG (surface antigen)

64
Q

Which antibody will persist for life after hepatitis B exposure?

A

Anti-HBc

65
Q

Which antibody would suggest recovery, immunity or successful vaccination against hepatitis B?

A

Anti-HBs

66
Q

What does the presence of the HBeAg mean in a hepatitis infection?

A

Virus is replicating so there are high levels of the hepatitis B virus

67
Q

What does the presence of anti-HBe mean in a hepatitis infection?

A

Long-term clearance after antiviral therapy

68
Q

Give 3 potential complications of a hepatitis B infection

A

Hepatocellular carcinoma
Fulminant liver failure
Cirrhosis

69
Q

How is hepatitis C spread?

A

Blood transfusion, IVDU, sexual contact

70
Q

What is autoimmune hepatitis?

A

Production of autoimmune antibodies against hepatocyte surface antigens.

71
Q

Which conditions are strongly associated with autoimmune hepatitis?

A 
Thyroid disease
RA
UC
Type 1 diabetes 
Hypergammaglobulinemia
72
Q

Give 5 symptoms of autoimmune hepatitis

A

Fatigue, malaise, joint pains, anorexia, nausea, vomiting, itching, rash, excessive hair growth, diarrhoea, amenorrhoea, bloating, oedema, ascites, confusion, jaundice, bruising, dark urine, pale stools

73
Q

What might be seen on a liver biopsy of a patient with autoimmune hepatitis?

A

Inflammation

Bridging necrosis

74
Q

Which antibody will be positive in autoimmune hepatitis:?

A

Anti-smooth muscle antibody (ASMA)

ANA negative

75
Q

How is autoimmune hepatitis treated?

A

Prednisolone
Azathioprine (keeps patient in remission)
Liver transplant

76
Q

What is the main bacterial cause of a pyogenic liver abscess in children?

A

Staphylococcus aureus

77
Q

What is the main bacterial cause of a pyogenic liver abscess in adults?

A

E. coli

78
Q

How is a pyogenic liver abscess treated?

A

Amoxicillin, ciprofloxacin, metroniadazole

79
Q

What is liver cirrhosis?

A

Chronic scarring of the liver which prevents it from functioning normally.

80
Q

Give 5 symptoms of liver cirrhosis

A

Fatigue, nausea, loss of appetite, loss of sex drive, jaundice, haematemesis, itchy skin, melaena, bruising, oedema, ascites

81
Q

Give 5 signs of liver cirrhosis

A

Leukonychia, clubbing, palmar erythema, spider naevi, gynaecomastia, loss of body hair

82
Q

Give 3 causes of liver cirrhosis

A

Alcohol excess
Hepatitis
Fatty liver disease

83
Q

How is liver cirrhosis diagnosed?

A 
Transient elastography
LFTs
Ultrasound 
Liver biopsy
CT/MRI
Endoscopy to check for varices
Check alpha fetoprotein for signs of HCC every 6 months
84
Q

How is liver cirrhosis treated?

A 
Stop drinking alcohol 
Lose weight 
Treat any treatable cause
Cholestyramine (treats itching) 
Interferon-alpha
Spironolactone 
Liver transplant
85
Q

Which criteria are included in the Child-Pugh criteria for a liver transplant?

A 
Serum bilirubin 
Serum albumin 
Presence of ascites
Encephalopathy 
INR
86
Q

What is the main type of primary liver cancer?

A

Hepatocellular carcinoma

87
Q

What is cholangiocarcinoma?

A

Cancer of the bile ducts inside the liver

88
Q

Give 4 symptoms of primary liver cancer

A

weight loss, ascites, jaundice, loss of appetite, nausea, vomiting, itching, fever

89
Q

How is liver cancer diagnosed?

A

LFTs, FBC, U&Es, alpha fetoprotein, ultrasound, CT, MRI, biopsy, laparoscopy

90
Q

How is a stage 1 liver cancer treated?

A

Surgery
Liver transplant
Radiofrequency ablation

91
Q

How is a stage 4 liver cancer treated?

A

Biological therapy
Chemotherapy
Treat symptoms
Palliative care

92
Q

What is primary biliary cholangitis?

A

The intralobular ducts in the liver are damaged by chronic autoimmune granulomatous inflammation which leads to fibrosis, cirrhosis and portal hypertension.

93
Q

What antibody is present in PBC patients?

A

Antimicrobial antibodies

94
Q

Give 4 signs of PBC

A 
Jaundice
Skin pigmentation 
Xanthelasma
Xanthomata
Hepatosplenomegaly
95
Q

Give 4 symptoms of PBC

A

Bone and joint aches, fatigue, itchy skin, dry eyes, dry mouth, RUQ pain

96
Q

Give 4 potential complications of PBC

A 
Cirrhosis
Osteoporosis
Malabsorption of vitamins A, D, E, K 
Osteomalacia
Coagulopathy 
Portal hypertension 
Ascites
97
Q

How is PBC diagnosed?

A

LFTs, bilirubin, albumin, clotting, immunoglobulins, cholesterol, ultrasound

98
Q

What is the M rule in regards to PBC?

A

IgM
Anti-Mitochondrial antibodies, M2 subtype
Middle aged females

99
Q

What other conditions is PBC strongly linked to?

A

RA
SLE
Thyroid disease
Sjogren’s syndrome

100
Q

How is PBC managed?

A 
Avoid NSAIDs
Ursodeoxycholic acid
Obeticholic acid
Cholestyramine 
Vitamin A, D, E, K supplements
Rifampicin and naltrexone to reduce itching 
Liver transplant
101
Q

What is primary sclerosing cholangitis?

A

Bile ducts progressively decrease in size due to inflammation and fibrosis. The bile accumulates in the liver and causes liver cirrhosis

102
Q

Give 3 symptoms of PSC

A 
Tiredness
RUQ pain 
Itching
Jaundice
Fever with chills
103
Q

Give 3 complications of PSC

A 
Liver failure
Bile duct cancer
Bowel cancer
Liver cancer
Gallbladder cancer
104
Q

How is PSC diagnosed?

A

Cholangiogram, liver biopsy, LFTS, bilirubin, albumin

105
Q

How is PSC treated?

A 
Ursodeoxycholic acid
Cholestyramine 
Rifampicin 
Naltrexone
Vitamin A, D, E, K supplements 
Liver transplant
106
Q

What is Wilson’s disease?

A

Excess copper in the body due to a genetic defect in metabolising copper

107
Q

What are the symptoms of Wilson’s disease?

A

Jaundice, abdominal pain, ascites, haematemesis, clumsiness, loss of muscle control, contractions, bradykinesia, slurred voice, dysphagia, personality change, anxiety, delusions

108
Q

Give a common sign of Wilson’s disease

A

Brown ring around the cornea of the eye (Kayser-Fleischer ring)

109
Q

How is Wilson’s disease treated?

A

Remove copper from diet
D-penicillamine (removes copper from the body)
Liver transplant

110
Q

How is hereditary hemochromatosis inherited?

A

Autosomal recessive

111
Q

What is hereditary haemochromatosis?

A

Excessive iron accumulation in the body due to a gene abnormality which increases the amount of iron absorbed from the gut.

112
Q

Give 4 symptoms and signs of hereditary haemochromatosis

A

Fatigue, limb weakness, joint pain, stomach pain, loss of sex drive, impotence, cardiomyopathy, jaundice, confusion, mood swings, depression, bronze skin, hypogonadism, arthritis, liver cirrhosis

113
Q

How is hereditary hemochromatosis diagnosed?

A 
Transferrin saturation 
Serum ferritin 
Genetic screening
LFTs
Liver biopsy
114
Q

How is hereditary hemochromatosis treated?

A

Phlebotomy- regular bleeding to remove excess iron
Liver transplant
Reduce dietary iron

Phase 2- Gen Med (7 decks)

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