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CP2 - CBM > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What is dyspepsia?

A

‘indigestion’ - painful, difficult or disturbed digestion

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2
Q

What is reflux?

A

Return of the stomach contents back up the oesophagus

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3
Q

What are the causes of dyspepsia?

A

GORD
Functional dyspepsia (due to hypersensitive mucosa, gastric stretch pain, stress)
Peptic ulcer e.g. H.pylori bacteria and NSAIDs damage the mucosa, smoking - increases acid in the stomach

Others - cancer, gastritis

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4
Q

What are the causes of GORD?

A

Relaxation of the GO sphincter - due to smoking, oestrogen

Deformity of the GO sphincter - due to hiatus hernia

Mechanical pressure on the stomach - e.g. due to obesity, pregnancy, cough

Lack of salivary flushing of the oesophagus - due to anticholinergic use

Lack of gastric motility - e.g. due to diabetes

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5
Q

What are the major common symptoms of dyspepsia?

A

Regurgiation
Retrosternal pain (heartburn)
Epigastric pain

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6
Q

What are the less important signs and symptoms of dyspepsia?

A 
bloating 
nausea
vomiting 
sleep disturbances 
cough on lying down
irritability
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7
Q

What are the severe symptoms of peptic ulceration?

A

dark or black stool - due to bleeding
vomiting - coffee grounds
severe pain in the mid to upper abdomen
weight loss

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8
Q

What differentiates duodenal ulcers from gastric ulcers?

A

Duodenal - pain 2-3 hours after meal, eating relieves pain

gastric - pain 0.5-1 hour after meals - eating aggravates pain

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9
Q

What are the risk factors for dyspepsia/GORD?

A 
obesity
pregnancy
smoking
diabetes
asthma
hiatus hernia 
excessive alcohol consumption 
stress
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10
Q

What investigations can be done for dyspepsia?

A

H.Pylori - carbon 13 breath test

Upper GI endoscopy if significant upper GI bleeding or persistent symptoms

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11
Q

What is the treatment of GORD?

A

suspend harmful drugs use:
NSAIDs, biphosphonates, corticosteroids, CCBs, theophyllines

antacid
full dose PPI (omeprazole) for 4 weeks
H2 antagonist if inadequate response to PPI

Specialist referral if unresponsive ?fundoplication

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12
Q

What is the management of peptic ulcer?

A

If H Pylori positive - antibiotic triple therapy vs H pylori: 7day course PPI + amoxicillin + clarythromycin

then retest after 6-8 weeks

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13
Q

What is the mx of reflux

A

Long term PPI or H2 antagonist

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14
Q

What is the mx of Barrett’s oesophagus?

A

Endoscopic surveillance to check for progression of cancer - annual review of symptoms

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15
Q

What is IBS?

A

A widespread condition commonly involving recurrent abdominal pain and diarrhoea or constipation, with no identifiable underlying organic pathology

Generally associated with stress, anxiety, depression or previous intestinal infections

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16
Q

What are the theories of causes of IBS?

A

Abnormal GI transit profiles
Colonic muscle hyper/hypo activity
psychological illness resulting in the production of pro-inflammatory cytokines

17
Q

What are the signs and symptoms of IBS?

A 
?altered bowel habits
abdominal pain and/or distension 
postprandial urgency 
dyspepsia
urinary symptoms 
nausea and vomiting 
stressor-related symptoms
18
Q

describe the pathophysiology of IBS?

A

triad of:
altered GI motility
Visceral hyperalgesia
psychopathology

underlying mechanism still unproven, microscopic inflammation

19
Q

What are the risk factors for IBS?

A

Female > Male
Age - teenager - 50s
family history
Emotional disturbances and/or mental illness
Food sensitivities
Some medications - antibiotics, antidepressants, drugs made with sorbitol
Other digestive problems

20
Q

What investigations can be done for IBS?

A

FBC, ESR, CRP
Coeliac screen
CA125 for women with symptoms that could be ovarian cancer
Faecal calprotectin for those with symptoms that could by IBD

21
Q

What is the management of IBS?

A

Reassurance and explanation
long term condition

diet and exercise
symptom related medication

22
Q

What medications can be given for IBS?

A

Loperamide to manage diarrhoea and laxatives to manage constipaiton

antispasmodics for abdominal pain and spasms - mebeverine
antidepressants
antibiotics to alter the GI tract bacterial composition (rifaximin or neomycin)

23
Q

What is the peak age of incidence of IBS?

A

20-30

24
Q

What criteria warrant 2ww referral to Gastro in GORD?

A 
ALARMS 55
Anaemia 
Loss of weight 
Anorexia 
Masses/melaena 
Swallowing difficulty 
55+ years old

CP2 - CBM (5 decks)

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