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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
What is the treatment for coeliac disease?
Gluten free diet for life
26
Give 4 potential complications of coeliac disease
Osteoporosis Lactose intolerance Lymphoma Small bowel cancer
27
What is pancreatitis?
Inflammation of the pancreas
28
Give 5 causes of acute pancreatitis
``` GET SMASHED Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion bite Hyperlipidaemia ERCP Drugs ```
29
Which drugs can cause pancreatitis?
``` Azathioprine Thiazide Sulfasalazine Trimethoprim Tetracycline ```
30
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 ```
31
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) ```
32
How is acute pancreatitis treated?
Fluids Oxygen Painkillers Treat underlying cause
33
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
34
What is chronic pancreatitis?
Long-term inflammation of the pancreas
35
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 ```
36
Give 3 causes of chronic pancreatitis
``` Alcoholism Autoimmune Trauma Smoking Radiotherapy side effect ```
37
How is chronic pancreatitis treated?
``` Avoid alcohol Stop smoking Low fat diet Enzyme supplements Corticosteroids Pain relief Pancreas resection or total pancreatectomy ```
38
Give 4 risk factors for developing pancreatic cancer
``` Smoking Alcohol Previous cancer Diet Previous radiotherapy Obesity ```
39
Gve 4 causes of pancreatic cancer
``` Chronic pancreatitis Stomach ulcers Diabetes H.pylori infection Hepatitis ```
40
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
41
What is a Whipple's procedure?
Removal of the head of the pancreas, duodenum, gallbladder, bile duct and stomach
42
What is a carcinoid tumour?
A group of tumours which all have an enterochromaffin cell origin and so can produce 5-HT.
43
Where are carcinoid tumours commonly found?
Appendix, ileum, rectum, ovaries, testes, bronchi
44
What things can carcinoid tumours secrete?
Bradykinin, tachykinin, substance P, gastrin, insulin, glucagon, ACTH, PTH, thyroid hormones
45
Give 3 complications of carcinoid tumours
Appendicitis Bowel obstruction Carcinoid syndrome (effects of the hormones) Carcinoid crisis
46
What is non-alcoholic fatty liver disease?
Fat accumulation around the liver not associated with excessive alcohol intake.
47
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
48
Give 4 symptoms of non-alcoholic fatty liver disease
Jaundice, easy bruising, dark urine, ascites, haematemesis, melena, encephalopathy, pruritis
49
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)
50
How is non-alcoholic fatty liver disease treated?
Reduce weight, exercise, control blood pressure, cholesterol and diabetes
51
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 ```
52
Give 2 signs of liver failure
Jaundice Ascites Encephalopathy Pear drop smell on the breath
53
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
54
How is liver failure treated?
IV fluid, treat the cause, avoid drugs with liver metabolism, liver transplant
55
Give 4 complications of liver failure
Cerebral oedema, ascites, bleeding, infection, hypoglycaemia, encephalopathy
56
What type of virus is hepatitis A?
RNA
57
What are the symptoms of hepatitis A?
Fever, malaise, anorexia, arthralgia, nausea, jaundice, hepatomegaly, splenomegaly
58
How is hepatitis A spread?
Fecal oral | Shellfish
59
How is hepatitis A treated?
Self-limiting | Treat symptoms
60
Which patients are at high risk of hepatitis B?
IV drug users, health workers, MSM, haemophiliacs, hemodialysis, prison staff, babies with infected mothers.
61
How can hepatitis B be transmitted?
Contaminated blood products Sexually Sharing needles (IVDU)
62
What are the symptoms and signs of hepatitis B?
Fever, malaise, anorexia, nausea, jaundice, hepatomegaly, splenomegaly, adenopathy
63
Which antigen is present when a hepatitis B patient is infectious?
HBsAG (surface antigen)
64
Which antibody will persist for life after hepatitis B exposure?
Anti-HBc
65
Which antibody would suggest recovery, immunity or successful vaccination against hepatitis B?
Anti-HBs
66
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
67
What does the presence of anti-HBe mean in a hepatitis infection?
Long-term clearance after antiviral therapy
68
Give 3 potential complications of a hepatitis B infection
Hepatocellular carcinoma Fulminant liver failure Cirrhosis
69
How is hepatitis C spread?
Blood transfusion, IVDU, sexual contact
70
What is autoimmune hepatitis?
Production of autoimmune antibodies against hepatocyte surface antigens.
71
Which conditions are strongly associated with autoimmune hepatitis?
``` Thyroid disease RA UC Type 1 diabetes Hypergammaglobulinemia ```
72
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
73
What might be seen on a liver biopsy of a patient with autoimmune hepatitis?
Inflammation | Bridging necrosis
74
Which antibody will be positive in autoimmune hepatitis:?
Anti-smooth muscle antibody (ASMA) | ANA negative
75
How is autoimmune hepatitis treated?
Prednisolone Azathioprine (keeps patient in remission) Liver transplant
76
What is the main bacterial cause of a pyogenic liver abscess in children?
Staphylococcus aureus
77
What is the main bacterial cause of a pyogenic liver abscess in adults?
E. coli
78
How is a pyogenic liver abscess treated?
Amoxicillin, ciprofloxacin, metroniadazole
79
What is liver cirrhosis?
Chronic scarring of the liver which prevents it from functioning normally.
80
Give 5 symptoms of liver cirrhosis
Fatigue, nausea, loss of appetite, loss of sex drive, jaundice, haematemesis, itchy skin, melaena, bruising, oedema, ascites
81
Give 5 signs of liver cirrhosis
Leukonychia, clubbing, palmar erythema, spider naevi, gynaecomastia, loss of body hair
82
Give 3 causes of liver cirrhosis
Alcohol excess Hepatitis Fatty liver disease
83
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 ```
84
How is liver cirrhosis treated?
``` Stop drinking alcohol Lose weight Treat any treatable cause Cholestyramine (treats itching) Interferon-alpha Spironolactone Liver transplant ```
85
Which criteria are included in the Child-Pugh criteria for a liver transplant?
``` Serum bilirubin Serum albumin Presence of ascites Encephalopathy INR ```
86
What is the main type of primary liver cancer?
Hepatocellular carcinoma
87
What is cholangiocarcinoma?
Cancer of the bile ducts inside the liver
88
Give 4 symptoms of primary liver cancer
weight loss, ascites, jaundice, loss of appetite, nausea, vomiting, itching, fever
89
How is liver cancer diagnosed?
LFTs, FBC, U&Es, alpha fetoprotein, ultrasound, CT, MRI, biopsy, laparoscopy
90
How is a stage 1 liver cancer treated?
Surgery Liver transplant Radiofrequency ablation
91
How is a stage 4 liver cancer treated?
Biological therapy Chemotherapy Treat symptoms Palliative care
92
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.
93
What antibody is present in PBC patients?
Antimicrobial antibodies
94
Give 4 signs of PBC
``` Jaundice Skin pigmentation Xanthelasma Xanthomata Hepatosplenomegaly ```
95
Give 4 symptoms of PBC
Bone and joint aches, fatigue, itchy skin, dry eyes, dry mouth, RUQ pain
96
Give 4 potential complications of PBC
``` Cirrhosis Osteoporosis Malabsorption of vitamins A, D, E, K Osteomalacia Coagulopathy Portal hypertension Ascites ```
97
How is PBC diagnosed?
LFTs, bilirubin, albumin, clotting, immunoglobulins, cholesterol, ultrasound
98
What is the M rule in regards to PBC?
IgM Anti-Mitochondrial antibodies, M2 subtype Middle aged females
99
What other conditions is PBC strongly linked to?
RA SLE Thyroid disease Sjogren's syndrome
100
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 ```
101
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
102
Give 3 symptoms of PSC
``` Tiredness RUQ pain Itching Jaundice Fever with chills ```
103
Give 3 complications of PSC
``` Liver failure Bile duct cancer Bowel cancer Liver cancer Gallbladder cancer ```
104
How is PSC diagnosed?
Cholangiogram, liver biopsy, LFTS, bilirubin, albumin
105
How is PSC treated?
``` Ursodeoxycholic acid Cholestyramine Rifampicin Naltrexone Vitamin A, D, E, K supplements Liver transplant ```
106
What is Wilson's disease?
Excess copper in the body due to a genetic defect in metabolising copper
107
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
108
Give a common sign of Wilson's disease
Brown ring around the cornea of the eye (Kayser-Fleischer ring)
109
How is Wilson's disease treated?
Remove copper from diet D-penicillamine (removes copper from the body) Liver transplant
110
How is hereditary hemochromatosis inherited?
Autosomal recessive
111
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.
112
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
113
How is hereditary hemochromatosis diagnosed?
``` Transferrin saturation Serum ferritin Genetic screening LFTs Liver biopsy ```
114
How is hereditary hemochromatosis treated?
Phlebotomy- regular bleeding to remove excess iron Liver transplant Reduce dietary iron

Phase 2- Gen Med (7 decks)

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