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Module 2 > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What is achalasia?

A

Inability of the oesophageal muscles to relax

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2
Q

What is scleroderma?

A

An autoimmune condition whereby the throat and oesophageal muscles become stiffened.

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3
Q

2 red flags of dysphagia

A
  1. Odynophagia

2. Worsening/constant dysphagia

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4
Q

Name 5 types of diarrhoea

A
  1. Secretory
  2. Osmotic
  3. Exudative
  4. Inflammatory
  5. Dysentery
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5
Q

What is secretory diarrhoea?

A

Excess active secretion and inhibition of absorption of anions. E.G - Cholera infection.

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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.

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7
Q

What is exudative diarrhoea?

A

Presence of blood and pus in the stool. E.G. IBD, E. coli infection.

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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.

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9
Q

What is dysentery?

A

Visible blood in stools. Can be caused by Shigella or Amoebic entamoeba histolytic parasites.

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10
Q

2 common causes of gastroenteritis?

A
  1. Bacteria - Campylobacter

2. Virus - Norovirus (adults), rotavirus (young children).

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11
Q

Who is at risk of gram + C. diff infection?

A

Elderly people, those treated with Abx in hospital

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12
Q

What is the likely underlying pathology in someone with small volume, frequent diarrhoea?

A

Large bowel disease

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13
Q

What are the red flag symptoms for diarrhoea?

A

> 4 weeks of symptoms, blood, weight loss, nocturnal diarrhoea.

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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.

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15
Q

Pre-hepatic jaundice is caused by

A

Increased rate of haemolytic - Genetic disorders (SCA, thalassaemia), malaria, sepsis

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16
Q

3 causes of hepatic jaundice

A
  1. Impaired bilirubin uptake
  2. Defective bilirubin conjugation
  3. Abnormal bilirubin secretion
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17
Q

3 RF of hepatic jaundice

A
  1. Alcohol/cirrhosis
  2. Hepatitis
  3. Premature birth
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18
Q

Post-hepatic jaundice is due to

A

Impaired drainage of bile (contains conjugated bilirubin)

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19
Q

5 causes of post-hepatic jaundice

A
  1. Pregnancy
  2. Gallstones (common bile duct)
  3. Gallbladder strictures (common bile duct)
  4. Cholangiocarcinoma
  5. Pancreatic cancer (head of pancreas)
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20
Q

A pale brown stool colour suggests what 2 types of jaundice?

A
  1. Hepatic

2. Post-hepatic

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21
Q

Dark urine, due to reduced urobilinogen, is seen in what 2 types of jaundice?

A
  1. Hepatic

2. Post-hepatic

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22
Q

Name 5 hepatotoxic drugs

A
  1. Warfarin
  2. Phenytoin
  3. Prednisolone
  4. Fusidic acid
  5. Rifampicin
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23
Q

What are the 2 main types of anti-emetics?

A
  1. H1 receptor antagonists/piperazines - Cyclizine (GI), cinnarizine (vestibular)
  2. D2 receptor antagonists: Metoclopramide (GI), prochlorperazine (vestibular)
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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.

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25
Q

What region of the colon is found in the right iliac fossa?

A

Caecum

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26
Q

What region of the colon is found in the suprapubic or left iliac fossa?

A

Sigmoid colon

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27
Q

What are the 3 types of acute abdominal pain?

A
  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
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28
Q

Small bowel obstruction is commonly caused by

A

Adhesions and hernias

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29
Q

Large bowel obstructions are commonly caused by (4 points)

A

Colon cancer, constipation, diverticular stricture, volvulus

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30
Q

5 causes of constipation

A
  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
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31
Q

What type of tear is a MW tear?

A

Longitudinal mucosal, at the gastro-oesophageal junction

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32
Q

5 RFs for a MW tear

A

Alcoholism, vomiting/retching, bulimia, hiatus hernia, chronic cough

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33
Q

What are the 2 types of oesophageal cancer and where does each tend to affect?

A
  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.
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34
Q

RF for oesophageal squamous cell carcinoma

A

Smoking, alcohol

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35
Q

RF for oesophageal adenocarcinoma

A

Male, GORD, excess alcohol, obesity

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36
Q

Specific symptoms seen in oesophageal squamous cell carcinoma

A

Chronic cough and hoarse voice (as cancer is found in proximal regions)

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37
Q

4 causes of oesophageal strictures

A
  1. Infection - Oesophagitis
  2. Fibrosis: Commonly due to GORD
  3. Neoplasms
  4. Radiotherapy
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38
Q

What type of veins are affected in oesophageal varices and where are they found?

A

Submucosal veins in the lower third of the oesophagus

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39
Q

Where does blood backup in portal hypertension?

A
  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
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40
Q

How does portal hypertension impair liver function?

A

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.

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41
Q

Management for bleeding oesophageal varices

A
  • Injection: Octreotide or glypressin
  • Sclerotherapy: Surgical scarring
  • Variceal banding/ligation
  • Transjugular intrahepatic portal systemic shunt
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42
Q

Oesophagitis can be caused by

A

Allergies (eosinophilic oesophagus) or acid reflux

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43
Q

Pathophysiology behind GORD

A

The lower oesophageal sphinchter becomes incompetent and allows gastric contents to enter the oesophagus.

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44
Q

What are antacids? What do antacids containing Mg, Ca and Al cause?

A

Stomach acid neutralisers, commonly containing magnesium (causes diarrhoea) or calcium (constipation, kidney stones) or aluminium (osteoporosis)

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45
Q

What is the role of alginates?

A

Alginates or alginic acid are added to antacids to function as a barrier to excessive stomach acid.

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46
Q

How do proton pump inhibitors function?

A

PPIs inhibit the proton pump of the gastric parietal cell to prevent the release of stomach acid.

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47
Q

PPIs increase the risk of what 3 conditions

A
  1. Subacute cutaneous lupus
  2. Osteoporosis
  3. GI infection - C.diff
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48
Q

Side effects of PPIs

A

GI complaints, dizziness, headache, insomnia, dry mouth.

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49
Q

What are H2 receptor antagonists usually used to treat?

A

Peptic ulcers - they reduce gastric acid to relieve symptoms.

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50
Q

Gastroenteritis damages what area of the intestine?

A

Villous brush border membrane; intestinal contents aren’t absorbed - diarrhoea and toxins promote release of chloride ions.

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51
Q

2 RF for peptic ulcers?

A

H. pylori infection and NSAIDs

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52
Q

Do stomach ulcers hurt before or after eating?

A

Stomach ulcers hurt after eating

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53
Q

Do duodenal ulcers hurt before or after eating?

A

Duodenal ulcers hurt before eating

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54
Q

What is the most common type of gastric cancer?

A

Adenocarcinoma - glandular cells become epithelial cells but have glandular characteristics. Invasive cancer, affecting the muscularis mucosa, submucosa and the muscularis propria.

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55
Q

RF/epidemiology for gastric cancer (7 points)

A
  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
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56
Q

Where does stomach cancer metastasise to?

A

The bone

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57
Q

Red flags of stomach cancer

A

Dyspepsia > 1 month and > 50 years, weight loss, epigastric mass, enlarged Virchow’s node, acanthuses nigricans

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58
Q

Where does Crohn’s Disease tend to affect?

A

Anywhere from mouth-anus, but most likely the ileum

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59
Q

Where does UC affect?

A

Colon and rectum

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60
Q

Signs/symptoms of Crohn’s Disease?

A

Skip lesions, diarrhoea, anaemia, ulcers, stearrhoea, fistulae

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61
Q

Signs/symptoms of ulcerative colitis?

A

Bloody diarrhoea, tenesmus, mucus/blood in stool

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62
Q

What is the difference between diverticular disease/diverticulosis and diverticulitis?

A

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.

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63
Q

Where is most commonly affected in diverticular disease?

A

Sigmoid colon

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64
Q

3 signs/symptoms of diverticular disease?

A

Leukocytosis, rectal bleeding, general GI complaints

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65
Q

Signs/symptoms of diverticulitis?

A

Sharp iliac fossa pain, tenderness, guarding, lying still, systemic upset - nausea, anorexia

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66
Q

3 causes of appendicitis

A
  1. Faecal impaction
  2. Infection
  3. Lymphoid hyperplasia secondary to IBD
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67
Q

Acute mesenteric ischaemia is caused by

A

Embolism or thrombus formation

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68
Q

Chronic mesenteric ischaemia is caused by

A

Atherosclerosis/intestinal angina

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69
Q

Ischaemic colitis is caused by

A

Compromised blood supply to the colon

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70
Q

RF for AMI?

A

Mitral stenosis, aortic aneurysm, aortic dissection, AF, endocarditis.

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71
Q

RF for CMI?

A

Smoking, HTN, DM.

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72
Q

RF for IC?

A

Hernia, trauma, drugs, coagulation disorders.

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73
Q

Small bowel obstruction presents with what two features of AXR?

A

Dilatation > 3 cm and visible valvular conniventes.

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74
Q

Large bowel obstruction presents with what two features of AXR?

A

Dilatation > 6cm or > 9cm at caecum and visible austral lines.

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75
Q

Signs/symptoms of bowel obstruction?

A

Colicky abdominal pain, vomiting, distension, constipation, tinkling bowel sounds, elevated lactate

76
Q

What are the stages of colon cancer development?

A

Normal epithelium transforms to abnormal epithelium, before forming an adenoma that increases in size to give a colonic adenocarcinoma.

77
Q

Give 2 gene mutations that increase colon cancer risk

A

APC and HNPCC

78
Q

Right-sided CRC presents late with what symptoms

A

Abdominal pain, occult bleeding, anaemia, right iliac fossa mass

79
Q

Left-sided CRC presents with what symptoms

A

Rectal bleeding, bowel habit changes, tenesmus, left IF mass

80
Q

CRC red flags

A

Weight loss + abdominal pain > 40 years, unexplained rectal bleeding > 50 years

81
Q

Where are dilated haemorrhoid vessels found?

A

In the haemorrhoid plexus of the anal canal

82
Q

What is the main cause of haemorrhoids?

A

A rise in intraabdominal pressure.

83
Q

Where are external haemorrhoids found?

A

Below the dentate line, covered by squamous epithelium.

84
Q

Where are internal haemorrhoids found?

A

Above the dentate line, lined by rectal mucosa.

85
Q

3 symptoms of external haemorrhoids

A

Itching, pain around anus, fresh blood

86
Q

The main symptom of internal haemorrhoids

A

Painless bleeding

87
Q

Anal fissures present with

A

Severe broken glass burning pain on defecation, fresh blood on stool/tissue, anal spasm

88
Q

Anal cancer is what type of cancer?

A

Squamous cell carcinoma, associated with HPV infection

89
Q

2 urgent endoscopy referral criteria

A
  1. > 55 years with weight loss, abdo pain, reflux or dyspepsia.
  2. Dysphagia
90
Q

5 non-urgent endoscopy referral criteria

A
  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
Q

Most common cause of an upper GI bleed

A

Perforated peptic ulcer

92
Q

What score calculates the risk of an upper GI bleed?

A

Glasgow-Blatchford score

93
Q

What score calculates the risk of rebleeding and mortality post-endoscopy?

A

Rockall Score

94
Q

Bleeding oesophageal varices are treated with what 2 drugs?

A

Terlipressin and antibiotics

95
Q

5 management points for upper GI bleed

A
  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
Q

A patient who is on warfarin begins coughing up blood. What should you do?

A
  1. Stop warfarin and any other drugs that could cause the bleed (NSAIDs)
  2. Transufse prothrombin complex concentrate
97
Q

Stratified squamous epithelial cells transform into what cell type in Barrett’s oesophagus?

A

Simple columnar epithelium

98
Q

5 causes of gastritis

A
  1. Infection - H. pylori stimulates gastrin to secrete acid.
  2. Drugs - NSAIDs
  3. Alcohol/smoking
  4. Stress
  5. Autoimmune response
99
Q

Most common cause of gastroenteritis

A

Virus

100
Q

E. coli 0157 or Shigella both produce the shiga toxin. What syndrome does this cause and what are 3 symptoms?

A

Haemolytuc uraemia syndrome

Bloody diarrhoea, abdominal pain, fever.

101
Q

Who is most likely to get campylobacter jejuni gastroenteritis and what are 3 symptoms?

A

Travellers - spread in raw meat/untreated water

Watery diarrhoea, abdominal pain, vomiting

102
Q

Bacillus cereus has an acute or long onset?

A

Acute - commonly caused by food being left at room temperature, will pass within 24 hours.

103
Q

Most common cause of stomach cancer

A

H. pylori infection

104
Q

2 management points for peptic ulcers

A
  1. Avoid increase in acid triggers

2. PPIs

105
Q

3 RF for peptic ulcers

A

NSAIDs, steroids, H. pylori

106
Q

What impairs healing in peptic ulcer disease?

A

Smoking

107
Q

A baby who has poor growth and projectile vomits after feeding most likely has

A

Pyloric stenosis

108
Q

A newborn baby has an olive-shaped firm mass in their abdomen. What’s the diagnosis?

A

Pyloric stenosis

109
Q

What 2 bloods and 1 other test should be ordered to rule out organic causes of IBS-like symptoms?

A

FBCs (anaemia)
Anti-TGGs (Coeliac’s)
Faecal calprotectin (IBD)

110
Q

Abdominal pain that improves after opening bowels or associated with a change in bowel habit, with what other 2 symptoms can suggest IBS?

A

Any 2 from:

  • Abnormal stool passage
  • Bloating
  • PR mucus
  • Worsened after eating
111
Q

What laxative must be avoided in someone with IBS who experiences bloating?

A

Lactulose

112
Q

Smoking is a protective factor in

A

Ulcerative colitis

113
Q

Crohn’s signs/symptoms - NESTS

A 
No blood or mucus
Entire GI
Skip lesions
Terminal ileum with transmural inflammation
Smoking is a RF

+ weight loss, strictures and fistulas

114
Q

UC signs/symptoms - CLOSEUP

A 
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
Q

5 extraintestinal manifestations of Crohn’s

A
  1. Apthous ulcers
  2. Clubbing
  3. Erythema nodosum
  4. Nephritis
  5. T1DM
116
Q

2 signs of active IBD

A

Raised CRP and raised faecal calprotectin

117
Q

Crohn’s management (3 points)

A
  1. Oral prednisolone or IV hydrocortisone
  2. Immunosuppressant
  3. Surgery
118
Q

UC management (2 points)

A

Aminosalicylate (mesalazine) and corticosteroids

119
Q

UC surgery (2 points)

A

Panproctocolectomy - ileostomy formation or ileo-anal-anastomosis to give J pouch

120
Q

Diverticular disease affects which 2 layers

A

Mucosa and sub mucosa

121
Q

LIF pain and fever could be a sign of

A

Diverticulitis

122
Q

RF for diverticular perforation

A

NSAIDs

123
Q

The appendix is connected to what part of the bowel

A

Caecum

124
Q

Rebound tenderness in RIF suggests what condition and what does this mean?

A

Appendicitis

Deep palpation when released causes pain

125
Q

Rovsig’s sign describes

A

LIF palpation causes RIF pain

126
Q

Abdo pain with bile stained vomit is a sign of

A

Intussusception

127
Q

Metabolic acidosis and colicky abdominal pain with guarding is a sign of

A

AMI

128
Q

Toxic megacolon is caused by

A

Decreased mucosal blood supply - Inflammation (IBD) or infection

129
Q

IBD predisposes patients to what rectal condition

A

Fistulas and abscess

130
Q

Pilonidal disease is caused by what issue where within the sacrococcygeal area?

A

Trapped hair follicles create a chronic sinus tract in the natal cleft

131
Q

Most common cause of cholecystitis

A

Gallstones

132
Q

Where does RUQ pain in gallstones radiate to?

A

Shoulder

133
Q

What LFT markers are raised in cholecystitis caused by gallstones?

A

ALP, bilirubin, ALT/AST

134
Q

3 other causes of cholecystitis other than gallstones

A

Vasculitis, chemotherapy, trauma

135
Q

Post-prandial pain and nausea may be a sign of

A

Cholecystitis

136
Q

Gold-standard for detecting gallstones

A

US or MRCP

137
Q

When can a laparoscopic cholecystectomy be performed?

A

6 weeks after inflammation

138
Q

Charcot Triad refers to what 3 symptoms and what condition?

A

RUQ pain, fever, jaundice

Cholangitis

139
Q

2 main treatments for cholangitis

A

IV Abx and biliary tree drainage

140
Q

Who is most at risk of primary sclerosis cholangitis?

A

Men with IBD

141
Q

3 signs/symptoms of cholangiocarcinoma

A

Painless jaundice, weight loss, RUQ biliary colic

142
Q

3 cancer markers raised in cholangiocarcinoma

A

CA 19-1, CEA, CA-125

143
Q

What type of cancer is cholangiocarcinoma?

A

Adenocarcinoma

144
Q

3 causes of pancreatitis

A
  1. Gallstones
  2. Alcohol
  3. Post-ERCP trauma
145
Q

5 blood test findings indicative of pancreatitis

A
  1. Raised amylase and LDL
  2. Raised neutrophils
  3. Raised urea
  4. Low albumin
  5. Hypocalcaemia
146
Q

Epigastric pain that radiates to the back, tachycardia and fever could be signs of

A

Pancreatitis

147
Q

Complication of chronic pancreatitis

A

Pancreatic insufficiency

148
Q

Pancreatic cancer is what type of cancer and where does it affect?

A

Adenocarcinoma, head of pancreas

149
Q

4 met sites in pancreatic cancer

A

Liver
Peritoneum
Lungs
Bones

150
Q

Pancreatic cancer tumour marker

A

CA-19-9

151
Q

Most common hepatitis in the UK

A

B

152
Q

Hepatitis B infection pre-disposes you to what hepatitis?

A

D

153
Q

Hep A/E are RNA viruses spread via

A

Faecal-oral transmission

154
Q

Hep B/C/D are spread via

A

Infected blood/bodily fluid exposure

155
Q

PBC affects the

A

Intralobar ducts - Canals of Herring

156
Q

2 antibodies seen in PBC

A

Anti-mitochondrial antibodies and ANA

157
Q

3 RF for PBC

A
  1. Middle aged women
  2. Other autoimmune disease
  3. RA/Sjogren’s
158
Q

Haemochromatosis is caused by the HFE mutation on what chromosome

A

Chromosome 6

159
Q

Kayser-Fleischer rings are seen in

A

Wilson’s

160
Q

Mutation in ATP7B in Wilson’s in on what chromosome?

A

13

161
Q

What neurological issues does Wilson’s disease cause

A

Parkinsonism features - tremor, bradykinesia

162
Q

Non-alcoholic fatty liver disease is caused by what 5 RF

A
  1. Obesity
  2. T2DM
  3. Hypertension
  4. Smoking
  5. High cholesterol
163
Q

3 imaging investigations in fatty liver

A
  1. Liver US
  2. ENAFLD fibrosis score
  3. Fibroscan
164
Q

3 stages of alcoholic fatty liver disease

A
  1. Alcohol fatty liver
  2. Alcohol hepatitis
  3. Alcohol liver cirrhosis
165
Q

What is reduced in alcoholic fatty liver disease?

A

Synthetic function of the liver - Albumin, prothrombin (elevated time)

166
Q

Alcohol recommendations

A

< 14 units, drink over 3 days+ but no more than 5 units/day

167
Q

Cirrhosis is

A

Irreversible scarring

168
Q

HRS is defined as

A

Liver cirrhosis with rapidly decreasing renal function

169
Q

3 antidotes for paracetamol overdose

A
  1. Activated charcoal within 1 hour
  2. N-acetylcysteine
  3. Methionine
170
Q

5 drugs that can cause acute liver failure

A

Anticonvulsants: Phenytoin & Sodium valproate
Nitrofurantoin
Sulphonamides
Co-amoxiclav

171
Q

3 stages of management for hepatic encephalopathy

A
  1. Lactulose - prevents ammonia build up in stool
  2. Neomycin - destroys ammonia-releasing intestinal bacteria
  3. Rifaximin
172
Q

WK Syndrome is caused by

A

Thiamine/B1 deficiency

173
Q

Alpha-fetoprotein is a marker for

A

HCC

174
Q

3 roles of parietal cells

A
  1. Produce HCL
  2. Produce IF for VitB12 absorption
  3. Maintain H/K ion balance
175
Q

Endocrine function of pancreas (2)

A

Glucagon and insulin

176
Q

Exocrine function of pancreas

A

Digestive enzymes

177
Q

Secretin promotes the release of what

A

Bile

178
Q

Mesentery peritoneal structures such as the GI tract have the ability to

A

Move

179
Q

Diarrhoea RF (4)

A
  1. > 4weeks
  2. Nocturnal
  3. Blood/mucus/pus
  4. Weight loss
180
Q

Dark-red blood in vomit could indicate

A

Stomach bleeding - perforated ulcer

181
Q

Encopresis is also known as, and what age does it become pathological?

A

Faecal incontinence, age 4

182
Q

Surgery for constant, treatment-resistant GORD

A

Laparoscopic fundoplication

183
Q

Low Cl, low K in a premature baby is a sign of

A

Pyloric stenosis

184
Q

Itchy blisters on extensor surfaces and weight loss is a sign of what derm condition, and what gastro condition?

A

Dermatitis herpetiformis/ Coeliac disease

185
Q

HLA-DQ2 is most commonly seen in

A

Coeliac’s

186
Q

5 immune & antibody tests for Coeliac’s disease

A
  1. Total IgA
  2. IgG
  3. Anti-TTG
  4. Anti-EMA
  5. Anti-DGP

Module 2 (7 decks)

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