Gastroenterology Flashcards
1
Q
What is achalasia?
A
Inability of the oesophageal muscles to relax
2
Q
What is scleroderma?
A
An autoimmune condition whereby the throat and oesophageal muscles become stiffened.
3
Q
2 red flags of dysphagia
A
- Odynophagia
2. Worsening/constant dysphagia
4
Q
Name 5 types of diarrhoea
A
- Secretory
- Osmotic
- Exudative
- Inflammatory
- Dysentery
5
Q
What is secretory diarrhoea?
A
Excess active secretion and inhibition of absorption of anions. E.G - Cholera infection.
6
Q
What is osmotic diarrhoea and give 3 examples of where it is commonly seen?
A
Excess absorption of water. Seen in malabsorption disorders (Coeliacs, lactose intolerance) as well as excess Mg or VitC.
7
Q
What is exudative diarrhoea?
A
Presence of blood and pus in the stool. E.G. IBD, E. coli infection.
8
Q
What part of the bowel is damaged in inflammatory diarrhoea and what type of fluid is lost?
A
Damage to the mucosal brush border membrane leading to the loss of protein-rich fluid. Seen in a variety of infections and IBD.
9
Q
What is dysentery?
A
Visible blood in stools. Can be caused by Shigella or Amoebic entamoeba histolytic parasites.
10
Q
2 common causes of gastroenteritis?
A
- Bacteria - Campylobacter
2. Virus - Norovirus (adults), rotavirus (young children).
11
Q
Who is at risk of gram + C. diff infection?
A
Elderly people, those treated with Abx in hospital
12
Q
What is the likely underlying pathology in someone with small volume, frequent diarrhoea?
A
Large bowel disease
13
Q
What are the red flag symptoms for diarrhoea?
A
> 4 weeks of symptoms, blood, weight loss, nocturnal diarrhoea.
14
Q
What happens when heme is broken down?
A
Unconjugated bilirubin binds with albumin, where it is transported into the liver and made water-soluble.
15
Q
Pre-hepatic jaundice is caused by
A
Increased rate of haemolytic - Genetic disorders (SCA, thalassaemia), malaria, sepsis
16
Q
3 causes of hepatic jaundice
A
- Impaired bilirubin uptake
- Defective bilirubin conjugation
- Abnormal bilirubin secretion
17
Q
3 RF of hepatic jaundice
A
- Alcohol/cirrhosis
- Hepatitis
- Premature birth
18
Q
Post-hepatic jaundice is due to
A
Impaired drainage of bile (contains conjugated bilirubin)
19
Q
5 causes of post-hepatic jaundice
A
- Pregnancy
- Gallstones (common bile duct)
- Gallbladder strictures (common bile duct)
- Cholangiocarcinoma
- Pancreatic cancer (head of pancreas)
20
Q
A pale brown stool colour suggests what 2 types of jaundice?
A
- Hepatic
2. Post-hepatic
21
Q
Dark urine, due to reduced urobilinogen, is seen in what 2 types of jaundice?
A
- Hepatic
2. Post-hepatic
22
Q
Name 5 hepatotoxic drugs
A
- Warfarin
- Phenytoin
- Prednisolone
- Fusidic acid
- Rifampicin
23
Q
What are the 2 main types of anti-emetics?
A
- H1 receptor antagonists/piperazines - Cyclizine (GI), cinnarizine (vestibular)
- D2 receptor antagonists: Metoclopramide (GI), prochlorperazine (vestibular)
24
Q
What does ALARMS stand for when referencing dyspepsia red flags?
A
Anaemia, Loss of weight, Anorexia, Recent onset or progressive symptoms, Melaena/haematemesis, swallowing difficulty.
25
What region of the colon is found in the right iliac fossa?
Caecum
26
What region of the colon is found in the suprapubic or left iliac fossa?
Sigmoid colon
27
What are the 3 types of acute abdominal pain?
1. Obstruction - N&V, anorexia
2. Rupture (break in soft tissue) - Shock, abdominal. swelling
3. Perforation (abnormal opening in organ) - Shock, lying still, +ve cough test, tenderness and rigidity with guarding
28
Small bowel obstruction is commonly caused by
Adhesions and hernias
29
Large bowel obstructions are commonly caused by (4 points)
Colon cancer, constipation, diverticular stricture, volvulus
30
5 causes of constipation
1. Poor diet/lack of exercise/poor fluid/old-age
2. Anorectal disease
3. Intestinal obstruction
4. Hypercalcaemia, hypokalaemia
5. Drugs - opiates, anticholinergics, iron, furosemide, CCBs
31
What type of tear is a MW tear?
Longitudinal mucosal, at the gastro-oesophageal junction
32
5 RFs for a MW tear
Alcoholism, vomiting/retching, bulimia, hiatus hernia, chronic cough
33
What are the 2 types of oesophageal cancer and where does each tend to affect?
1. Squamous cell carcinoma - tends to affect the proximal region.
2. Adenocarcinoma - caused by Barret's oesophagus, whereby glandular cell in the distal oesophagus transform to form neoplastic intestinal cells.
34
RF for oesophageal squamous cell carcinoma
Smoking, alcohol
35
RF for oesophageal adenocarcinoma
Male, GORD, excess alcohol, obesity
36
Specific symptoms seen in oesophageal squamous cell carcinoma
Chronic cough and hoarse voice (as cancer is found in proximal regions)
37
4 causes of oesophageal strictures
1. Infection - Oesophagitis
2. Fibrosis: Commonly due to GORD
3. Neoplasms
4. Radiotherapy
38
What type of veins are affected in oesophageal varices and where are they found?
Submucosal veins in the lower third of the oesophagus
39
Where does blood backup in portal hypertension?
1. Lower region of the oesophagus
2. Superior region of the anal canal and rectum - gives haemorrhoids
3. Round-ligament of the liver/previously the umbilical vein - Caput media and spider naevi
4. Spleen - Can cause anaemia, leukopenia and thrombocytopenia
40
How does portal hypertension impair liver function?
The systemic backup of blood into the veins reduces blood supply to the liver, leading to the accumulation of toxic metabolites in the liver, diminished liver function and signs such as jaundice.
41
Management for bleeding oesophageal varices
- Injection: Octreotide or glypressin
- Sclerotherapy: Surgical scarring
- Variceal banding/ligation
- Transjugular intrahepatic portal systemic shunt
42
Oesophagitis can be caused by
Allergies (eosinophilic oesophagus) or acid reflux
43
Pathophysiology behind GORD
The lower oesophageal sphinchter becomes incompetent and allows gastric contents to enter the oesophagus.
44
What are antacids? What do antacids containing Mg, Ca and Al cause?
Stomach acid neutralisers, commonly containing magnesium (causes diarrhoea) or calcium (constipation, kidney stones) or aluminium (osteoporosis)
45
What is the role of alginates?
Alginates or alginic acid are added to antacids to function as a barrier to excessive stomach acid.
46
How do proton pump inhibitors function?
PPIs inhibit the proton pump of the gastric parietal cell to prevent the release of stomach acid.
47
PPIs increase the risk of what 3 conditions
1. Subacute cutaneous lupus
2. Osteoporosis
3. GI infection - C.diff
48
Side effects of PPIs
GI complaints, dizziness, headache, insomnia, dry mouth.
49
What are H2 receptor antagonists usually used to treat?
Peptic ulcers - they reduce gastric acid to relieve symptoms.
50
Gastroenteritis damages what area of the intestine?
Villous brush border membrane; intestinal contents aren't absorbed - diarrhoea and toxins promote release of chloride ions.
51
2 RF for peptic ulcers?
H. pylori infection and NSAIDs
52
Do stomach ulcers hurt before or after eating?
Stomach ulcers hurt after eating
53
Do duodenal ulcers hurt before or after eating?
Duodenal ulcers hurt before eating
54
What is the most common type of gastric cancer?
Adenocarcinoma - glandular cells become epithelial cells but have glandular characteristics. Invasive cancer, affecting the muscularis mucosa, submucosa and the muscularis propria.
55
RF/epidemiology for gastric cancer (7 points)
1. Men
2. East Asian/East European/South American
3. Smoking
4. Diet high in red meat/pickled vegetable
5. GORD
6. H. pylori.
7. Obesity
56
Where does stomach cancer metastasise to?
The bone
57
Red flags of stomach cancer
Dyspepsia > 1 month and > 50 years, weight loss, epigastric mass, enlarged Virchow's node, acanthuses nigricans
58
Where does Crohn's Disease tend to affect?
Anywhere from mouth-anus, but most likely the ileum
59
Where does UC affect?
Colon and rectum
60
Signs/symptoms of Crohn's Disease?
Skip lesions, diarrhoea, anaemia, ulcers, stearrhoea, fistulae
61
Signs/symptoms of ulcerative colitis?
Bloody diarrhoea, tenesmus, mucus/blood in stool
62
What is the difference between diverticular disease/diverticulosis and diverticulitis?
Diverticular disease is herniation of the mucosa/submucosa through the colonic muscular wall to form diverticular.
Diverticulitis is inflammation of the diverticula due to infection.
63
Where is most commonly affected in diverticular disease?
Sigmoid colon
64
3 signs/symptoms of diverticular disease?
Leukocytosis, rectal bleeding, general GI complaints
65
Signs/symptoms of diverticulitis?
Sharp iliac fossa pain, tenderness, guarding, lying still, systemic upset - nausea, anorexia
66
3 causes of appendicitis
1. Faecal impaction
2. Infection
3. Lymphoid hyperplasia secondary to IBD
67
Acute mesenteric ischaemia is caused by
Embolism or thrombus formation
68
Chronic mesenteric ischaemia is caused by
Atherosclerosis/intestinal angina
69
Ischaemic colitis is caused by
Compromised blood supply to the colon
70
RF for AMI?
Mitral stenosis, aortic aneurysm, aortic dissection, AF, endocarditis.
71
RF for CMI?
Smoking, HTN, DM.
72
RF for IC?
Hernia, trauma, drugs, coagulation disorders.
73
Small bowel obstruction presents with what two features of AXR?
Dilatation > 3 cm and visible valvular conniventes.
74
Large bowel obstruction presents with what two features of AXR?
Dilatation > 6cm or > 9cm at caecum and visible austral lines.
75
Signs/symptoms of bowel obstruction?
Colicky abdominal pain, vomiting, distension, constipation, tinkling bowel sounds, elevated lactate
76
What are the stages of colon cancer development?
Normal epithelium transforms to abnormal epithelium, before forming an adenoma that increases in size to give a colonic adenocarcinoma.
77
Give 2 gene mutations that increase colon cancer risk
APC and HNPCC
78
Right-sided CRC presents late with what symptoms
Abdominal pain, occult bleeding, anaemia, right iliac fossa mass
79
Left-sided CRC presents with what symptoms
Rectal bleeding, bowel habit changes, tenesmus, left IF mass
80
CRC red flags
Weight loss + abdominal pain > 40 years, unexplained rectal bleeding > 50 years
81
Where are dilated haemorrhoid vessels found?
In the haemorrhoid plexus of the anal canal
82
What is the main cause of haemorrhoids?
A rise in intraabdominal pressure.
83
Where are external haemorrhoids found?
Below the dentate line, covered by squamous epithelium.
84
Where are internal haemorrhoids found?
Above the dentate line, lined by rectal mucosa.
85
3 symptoms of external haemorrhoids
Itching, pain around anus, fresh blood
86
The main symptom of internal haemorrhoids
Painless bleeding
87
Anal fissures present with
Severe broken glass burning pain on defecation, fresh blood on stool/tissue, anal spasm
88
Anal cancer is what type of cancer?
Squamous cell carcinoma, associated with HPV infection
89
2 urgent endoscopy referral criteria
1. > 55 years with weight loss, abdo pain, reflux or dyspepsia.
2. Dysphagia
90
5 non-urgent endoscopy referral criteria
1. Haematemesis
2. Treatment resistant dyspepsia
3. Upper abdo pain and low Hb
4. Raised platelets with nausea/vomiting/weight loss/reflux/dyspepsia/upper abdo pain
5. Nausea/vomiting with weight loss/reflux/dyspepsia/upper pain
91
Most common cause of an upper GI bleed
Perforated peptic ulcer
92
What score calculates the risk of an upper GI bleed?
Glasgow-Blatchford score
93
What score calculates the risk of rebleeding and mortality post-endoscopy?
Rockall Score
94
Bleeding oesophageal varices are treated with what 2 drugs?
Terlipressin and antibiotics
95
5 management points for upper GI bleed
1. Nil by mouth/IV fluids
2. Bloods (FBC, U&Es, coagulation, LFT, group and save)
3. Blood transfusion - Bloods, plts, FFP in severe haemorrhage; platelets when thrombocytopenia and bleeding; prothrombin complex concentrate when patient is on warfarin and is bleeding
4. Urgent (24 hours) endoscopy to stop bleeding
5. Stop any bleed-inducing drugs
96
A patient who is on warfarin begins coughing up blood. What should you do?
1. Stop warfarin and any other drugs that could cause the bleed (NSAIDs)
2. Transufse prothrombin complex concentrate
97
Stratified squamous epithelial cells transform into what cell type in Barrett's oesophagus?
Simple columnar epithelium
98
5 causes of gastritis
1. Infection - H. pylori stimulates gastrin to secrete acid.
2. Drugs - NSAIDs
3. Alcohol/smoking
4. Stress
5. Autoimmune response
99
Most common cause of gastroenteritis
Virus
100
E. coli 0157 or Shigella both produce the shiga toxin. What syndrome does this cause and what are 3 symptoms?
Haemolytuc uraemia syndrome
| Bloody diarrhoea, abdominal pain, fever.
101
Who is most likely to get campylobacter jejuni gastroenteritis and what are 3 symptoms?
Travellers - spread in raw meat/untreated water
| Watery diarrhoea, abdominal pain, vomiting
102
Bacillus cereus has an acute or long onset?
Acute - commonly caused by food being left at room temperature, will pass within 24 hours.
103
Most common cause of stomach cancer
H. pylori infection
104
2 management points for peptic ulcers
1. Avoid increase in acid triggers
| 2. PPIs
105
3 RF for peptic ulcers
NSAIDs, steroids, H. pylori
106
What impairs healing in peptic ulcer disease?
Smoking
107
A baby who has poor growth and projectile vomits after feeding most likely has
Pyloric stenosis
108
A newborn baby has an olive-shaped firm mass in their abdomen. What's the diagnosis?
Pyloric stenosis
109
What 2 bloods and 1 other test should be ordered to rule out organic causes of IBS-like symptoms?
FBCs (anaemia)
Anti-TGGs (Coeliac's)
Faecal calprotectin (IBD)
110
Abdominal pain that improves after opening bowels or associated with a change in bowel habit, with what other 2 symptoms can suggest IBS?
Any 2 from:
- Abnormal stool passage
- Bloating
- PR mucus
- Worsened after eating
111
What laxative must be avoided in someone with IBS who experiences bloating?
Lactulose
112
Smoking is a protective factor in
Ulcerative colitis
113
Crohn's signs/symptoms - NESTS
```
No blood or mucus
Entire GI
Skip lesions
Terminal ileum with transmural inflammation
Smoking is a RF
```
+ weight loss, strictures and fistulas
114
UC signs/symptoms - CLOSEUP
```
Continuous inflammation
Limited to colon and rectum
Only superficial mucosa
Smoking is protective
Excrete blood/mucus
Use aminosalicylates
Primary sclerosis cholangiits
Diarrhoea
Abdominal pain
Passing blood
Weight loss
```
115
5 extraintestinal manifestations of Crohn's
1. Apthous ulcers
2. Clubbing
3. Erythema nodosum
4. Nephritis
5. T1DM
116
2 signs of active IBD
Raised CRP and raised faecal calprotectin
117
Crohn's management (3 points)
1. Oral prednisolone or IV hydrocortisone
2. Immunosuppressant
3. Surgery
118
UC management (2 points)
Aminosalicylate (mesalazine) and corticosteroids
119
UC surgery (2 points)
Panproctocolectomy - ileostomy formation or ileo-anal-anastomosis to give J pouch
120
Diverticular disease affects which 2 layers
Mucosa and sub mucosa
121
LIF pain and fever could be a sign of
Diverticulitis
122
RF for diverticular perforation
NSAIDs
123
The appendix is connected to what part of the bowel
Caecum
124
Rebound tenderness in RIF suggests what condition and what does this mean?
Appendicitis
| Deep palpation when released causes pain
125
Rovsig's sign describes
LIF palpation causes RIF pain
126
Abdo pain with bile stained vomit is a sign of
Intussusception
127
Metabolic acidosis and colicky abdominal pain with guarding is a sign of
AMI
128
Toxic megacolon is caused by
Decreased mucosal blood supply - Inflammation (IBD) or infection
129
IBD predisposes patients to what rectal condition
Fistulas and abscess
130
Pilonidal disease is caused by what issue where within the sacrococcygeal area?
Trapped hair follicles create a chronic sinus tract in the natal cleft
131
Most common cause of cholecystitis
Gallstones
132
Where does RUQ pain in gallstones radiate to?
Shoulder
133
What LFT markers are raised in cholecystitis caused by gallstones?
ALP, bilirubin, ALT/AST
134
3 other causes of cholecystitis other than gallstones
Vasculitis, chemotherapy, trauma
135
Post-prandial pain and nausea may be a sign of
Cholecystitis
136
Gold-standard for detecting gallstones
US or MRCP
137
When can a laparoscopic cholecystectomy be performed?
6 weeks after inflammation
138
Charcot Triad refers to what 3 symptoms and what condition?
RUQ pain, fever, jaundice
| Cholangitis
139
2 main treatments for cholangitis
IV Abx and biliary tree drainage
140
Who is most at risk of primary sclerosis cholangitis?
Men with IBD
141
3 signs/symptoms of cholangiocarcinoma
Painless jaundice, weight loss, RUQ biliary colic
142
3 cancer markers raised in cholangiocarcinoma
CA 19-1, CEA, CA-125
143
What type of cancer is cholangiocarcinoma?
Adenocarcinoma
144
3 causes of pancreatitis
1. Gallstones
2. Alcohol
3. Post-ERCP trauma
145
5 blood test findings indicative of pancreatitis
1. Raised amylase and LDL
2. Raised neutrophils
3. Raised urea
4. Low albumin
5. Hypocalcaemia
146
Epigastric pain that radiates to the back, tachycardia and fever could be signs of
Pancreatitis
147
Complication of chronic pancreatitis
Pancreatic insufficiency
148
Pancreatic cancer is what type of cancer and where does it affect?
Adenocarcinoma, head of pancreas
149
4 met sites in pancreatic cancer
Liver
Peritoneum
Lungs
Bones
150
Pancreatic cancer tumour marker
CA-19-9
151
Most common hepatitis in the UK
B
152
Hepatitis B infection pre-disposes you to what hepatitis?
D
153
Hep A/E are RNA viruses spread via
Faecal-oral transmission
154
Hep B/C/D are spread via
Infected blood/bodily fluid exposure
155
PBC affects the
Intralobar ducts - Canals of Herring
156
2 antibodies seen in PBC
Anti-mitochondrial antibodies and ANA
157
3 RF for PBC
1. Middle aged women
2. Other autoimmune disease
3. RA/Sjogren's
158
Haemochromatosis is caused by the HFE mutation on what chromosome
Chromosome 6
159
Kayser-Fleischer rings are seen in
Wilson's
160
Mutation in ATP7B in Wilson's in on what chromosome?
13
161
What neurological issues does Wilson's disease cause
Parkinsonism features - tremor, bradykinesia
162
Non-alcoholic fatty liver disease is caused by what 5 RF
1. Obesity
2. T2DM
3. Hypertension
4. Smoking
5. High cholesterol
163
3 imaging investigations in fatty liver
1. Liver US
2. ENAFLD fibrosis score
3. Fibroscan
164
3 stages of alcoholic fatty liver disease
1. Alcohol fatty liver
2. Alcohol hepatitis
3. Alcohol liver cirrhosis
165
What is reduced in alcoholic fatty liver disease?
Synthetic function of the liver - Albumin, prothrombin (elevated time)
166
Alcohol recommendations
< 14 units, drink over 3 days+ but no more than 5 units/day
167
Cirrhosis is
Irreversible scarring
168
HRS is defined as
Liver cirrhosis with rapidly decreasing renal function
169
3 antidotes for paracetamol overdose
1. Activated charcoal within 1 hour
2. N-acetylcysteine
3. Methionine
170
5 drugs that can cause acute liver failure
Anticonvulsants: Phenytoin & Sodium valproate
Nitrofurantoin
Sulphonamides
Co-amoxiclav
171
3 stages of management for hepatic encephalopathy
1. Lactulose - prevents ammonia build up in stool
2. Neomycin - destroys ammonia-releasing intestinal bacteria
3. Rifaximin
172
WK Syndrome is caused by
Thiamine/B1 deficiency
173
Alpha-fetoprotein is a marker for
HCC
174
3 roles of parietal cells
1. Produce HCL
2. Produce IF for VitB12 absorption
3. Maintain H/K ion balance
175
Endocrine function of pancreas (2)
Glucagon and insulin
176
Exocrine function of pancreas
Digestive enzymes
177
Secretin promotes the release of what
Bile
178
Mesentery peritoneal structures such as the GI tract have the ability to
Move
179
Diarrhoea RF (4)
1. > 4weeks
2. Nocturnal
3. Blood/mucus/pus
4. Weight loss
180
Dark-red blood in vomit could indicate
Stomach bleeding - perforated ulcer
181
Encopresis is also known as, and what age does it become pathological?
Faecal incontinence, age 4
182
Surgery for constant, treatment-resistant GORD
Laparoscopic fundoplication
183
Low Cl, low K in a premature baby is a sign of
Pyloric stenosis
184
Itchy blisters on extensor surfaces and weight loss is a sign of what derm condition, and what gastro condition?
Dermatitis herpetiformis/ Coeliac disease
185
HLA-DQ2 is most commonly seen in
Coeliac's
186
5 immune & antibody tests for Coeliac's disease
1. Total IgA
2. IgG
3. Anti-TTG
4. Anti-EMA
5. Anti-DGP
