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Phase 2a Revision > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

Coeliac Disease

A

Autoimmune T-cell mediated condition where exposure to gluten causes a reaction that causes inflammation in the small bowel.

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2
Q

Coeliac Disease Pathology

A
  • Gluten broken into Gliadin
  • Binds to IgA antibodies on gastric mucosa
  • Gliadin- Antibody complex presents to transferrin receptor
  • Complex endocytosed across gastric Mucosa into lamina propria
  • Tissue Transglutaminase removes an amide
  • Deaminated gliadin phagocytosed by HLADQ8/2 macrophages
  • Macrophages signal chimune response causing inflamm.
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3
Q

Coeliac Disease Symptoms

A

Inflammation causes: Crypt hyperplasia + Lymphocyte infiltration + Villous atrophy

→ Malabsorption = steatorrhoea & diarrhoea
→ Iron deficiency anaemia
→ Weight loss
→ Fatigue
→ Mouth ulcers
→ Dermatitis herpetiformis = bumpy papular

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4
Q

Coeliac Disease investigations & management

A

Gluten= more than 1 meal per day

  • Serology
    1st Line = Total IgA + tTG + antigliadin + anti endomysial antibodies
    Gold = duodenal biopsies - see villous atrophy, crypt hyperplasia, Raised intraepithelial lymphocytes

Management = Gluten free diet

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5
Q

Intestinal Obstruction Categories

A

→ Blockage

→ Pressure

→ Contraction

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6
Q

Intestinal obstruction Blockage causes

A
  • Tumour
  • Diaphragm disease - caused by NSAIDs
  • Crohn’s = fibrosis - coarctation - obstruction
  • Diverticular disease = Outpouching - faeces trapped
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7
Q

Intestinal obstruction Pressure causes

A
  • Adhesions
  • Volvulus - free floating areas with mesentery - Sigmoid
  • Intussusception
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8
Q

Intestinal Obstruction Contraction causes

A
  • Inflammation
  • Intramural tumours
  • Hirschsprung’s disease
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9
Q

Small bowel Obstruction Causes

A

Adults: Adhesions, Hernias, Crohn’s & Malignancy

Children: Volvulus, Intussusception, Hirschsprung ‘s, Appendicitis

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10
Q

Bowel obstruction Symptoms

A
  • Vomiting
  • Constipation/ Obstipation
  • Abdo pain & Distension
  • Tenesmus
  • Weight loss
  • Bowel sounds
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11
Q

Bowel obstruction signs

A

Perforation (peritonitis), Strangulation

Increased HR, Hypotension & High temp., Swelling

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12
Q

Bowel obstruction Investigations

A
  • Digital Rectal Exam- large bowel
  • X-Ray → Dilated jejunum / ileum, absense of gas distal to obstruction
  • FBC + U&E
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13
Q

Bowel obstruction Treatment

A
  • IV Fluids resus. (Nil by mouth)
  • BoweI decompression
  • Correct electrolyte imbalance
  • Analgesia & anti - emetics
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14
Q 
Definitions :
Diverticulum
Diverticulosis
Diverticular
Diverticulitis
A 
Diverticulum = Outpouches
Diverticulosis = asymptomatic condition of outpouches 
Diverticular = Symptomatic condition of outpouches
Diverticulitis = Inflammation of outpouches
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15
Q

Diverticulosis Risk factors

A
  • Low fibre diet
  • NSAIDs
  • COPD
  • Old age
  • Connective tissue disease
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16
Q

Diverticular /itis Symptoms & Investigations

A
  • LLQ tenderness
  • Constipation
  • Rectal bleeding
  • Fever
  • Diarrhoea

Investigations = CT or Colonoscopy

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17
Q

Diverticulitis Complications

A
  • Perforation
  • Peritonitis
  • Fistula
  • Obstruction
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18
Q

Diverticular/ osis Treatment

A

Diverticulosis: High fibre diet

Diverticular:

  • Bulk forming laxatives (Ispaghula husk)
  • Surgery

Contraindications : Stimulants (sena)

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19
Q

Diverticulitis Treatment

A

Mild:

  • 5 days of Co amoxiclav or Cephalexin with Metronidazole
  • Analgesics (not opioids / NSAIDs)
  • Liquid food

Severe:

  • Nil by mouth
  • IV Fluids & antibiotics
  • CT & Surgery
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20
Q

Stages of Nutrition

A

I. Ingestion

  1. Digestion
  2. Absorption
  3. Egestion
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21
Q

Malabsorption Causes

A
  • Intake
  • Digestion = Pancreatic / bile secretion
  • Absorption = Coeliac / Crohn’s - Villous atrophy
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22
Q

Malabsorption Symptoms

A
  • Diarrhoea
  • Steatorrhoea
  • Weight loss
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23
Q

Malabsorption Complications

A
  • Anaemia = low iron + Folate + B12
  • Bleeding disorder = low vit. K
  • Oedema = low protein
  • Bone disease = low vit. D

→ Tropical spure

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24
Q

Diarrhoea causes

A
  • Viral = Norovirus, Rota -virus
  • Bacteria = Staph. Aureus, Salmonella
  • Antibiotics - high risk of c.diff.
  • Drugs (NSAIDs)

→ IBD & IBS
→ Bowel cancer
→ Hyperthyroidism
→ Stress

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25
Q

Antibiotics that cause c. diff

A

→ Clindamycin
→ Co-amoxiclav
→ Cephalosporins
→ Ciprofloxacin

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26
Q

Diarrhoea Red Flags

A
  • Dehydration
  • Renal failure
  • Electrolyte imbalance
  • Rectal bleeding, weight loss → cancer
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27
Q

Diarrhoea Investigations

A
  • History

→ Floaty diarrhoea - Fat
→ Watery diarrhoea - Infection
→ Bloody diarrhoea - Inflammation / Cancer

  • Stool test = culture + test for blood
  • Blood test = culture + CRP (C - Reactive Protein)
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28
Q

Diarrhoea Treatment

A
  • Fluid & Electrolyte replacement
  • Antibiotics = Vancomycin
  • Antimotility agents
  • Antiemetics
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29
Q

IBS Types

A

→ IBS-D (Diarrhoea)

→ IBS-C (Constipation)

→ IBS-M (Mixed)

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30
Q

IBS Pathophysiology

A
  • Stress
  • Genetics
  • Signalling
  • Motility
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31
Q

IBS Symptoms

A
  1. Abdo pain & bloating relieved by defecation
  2. Mucus in stool
  3. Change in bowel habit - constipation, Straining
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32
Q

IBS Investigations

A
  • Bloods
  • ESR & CRP
  • Coeliac Serology
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33
Q

IBS Treatment

A

Mild:
Education + Low fodmap diet + Reassurance

Moderate:

  • Laxatives = Linaclotide or Bulk forming laxatives
  • Anti- motility agents = Loperamide
  • Antispasmodics
  • CBT or Hypnotherapy

Severe:
TCA (Tricyclic Acids)

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34
Q

Ulcerative Colitis

A

Autoimmune Disease where there’s inflammation & uIceration of colon & rectum

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35
Q

Crohn’s Disease

A

Immune related.
Bacteria over stimulating immune system - Mainly affects ileum
Never affects rectum.

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36
Q

Crohn’s Disease Pathology

A
  • Pathogens pass through Gl lining.
  • Mutation allows pathogens through mucosa into deep Submucosa.
  • Bacteria stimulates T- helper cells = releases cytokines = causes inflammation & granulomas = more cells = more cytokines = more inflammation
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37
Q

General & Specific symptoms in IBD

A
  • Diarrhoea
  • Abdo. pain & cramping
  • Mucous
  • Fever + Weight loss + Malaise

Specific =
→ Rectal pain in UC
→ Ileum therefore RLQ pain in Crohn’s
→ Inability to defecate

38
Q

Extra- Intestinal Symptoms - UC

A

UC:
→ Crypt abscesses
→ Pauci - arthritis
→ Enthesitis + Tenosynovitis + Dactylitis
→ Erythema Nodosum (raised red subcut. nodules)

39
Q

Extra- Intestinal Symptoms - Crohn’s

A

→ Any part of Gl Tract
→ Skip lesions
→ Deep Ulcers & fissures (cobblestone mucosa)

→ Transmural inflam.
→ Goblet cells

40
Q

IBD Complications

A

UC:

  • PR bleeding
  • Neoplasia
  • Toxic megacolon

Crohn’s:

  • Malabsorption
  • Fistula
  • strictured
  • Sinus tract
  • Obstruction & Abscess
41
Q

IBD Investigations & Monitoring

A
  • pANCA = - ve in Crohn’s , + ve in UC
  • Endoscopy with biopsy → Transmural inflam. & granulomas

Monitor :
→ Blood - CRP + ESR + Anaemia
→ Fecal occult blood test
→ Fecal calciprotein

42
Q

IBD Treatment - Mild / Moderate

A

1st Line = Aminosalicylates (mesalazine & sulfasalazine)
2nd Line = + Corticosteroids e.g. Prednisolone
3rd Line = + Calcineurin inhibitor (ciclosporin)
Biologics = Infliximab

Crohn’s

  • Prednisolone
  • Azathioprine
  • Infliximab
43
Q

IBD Treatment - Severe

A

1st Line = Calcineurin Inhibitor (ciclosporin) + corticosteroids

Immunosuppressive drugs [ Azathioprine & Methotrexate]

Gold = Biological Therapy [ Tumour Necrosis Factor alpha + Infliximab + Subcut. Golimumab ]

Last Line = Surgical resection then give Azathioprine + Metronidazole

44
Q

IBD Treatment contraception advice

A
  • Methotrexate = Contraception for male & female

- Monoclonal antibody & TNF alpha = Contraception for female

45
Q

Colorectal Cancer Symptoms

A
  • Blood & mucus in stool

- Mass

46
Q

Colon cancer Investigations

A
  • Endoscopy with biopsy
  • CT
  • Faecal occult blood
  • Tumour markers
  • Barium enema
47
Q

Colon cancer Treatment

A

Resection

48
Q

Main sites for Colon cancer

A

Descending colon + Sigmoid + Rectum

49
Q

Metastases for Colon cancer

A

Liver → Lungs → Bones > Peritoneum → Brain → Spinal cord

50
Q

Ischemic Colitis Causes + Symptoms

A

Causes:
→ Atherosclerosis of Superior & Inferior mesenteric artery
→ Thrombus/ Emboli
→ Low cardiac output & Arrhythmias

Symptoms:

  • LLQ pain
  • Bloody diarrhoea
51
Q

Ischemic Colitis Investigations

A
  • CT/ MRI angiography

- Colonoscopy .with biopsy

52
Q

Ischemic Colitis Treatment

A
  • Fluid replacement
  • Antibiotics
  • Surgery for perforation
53
Q

UC vs Crohn’s

A 
UC:
→ Ulcer goes through mucosa & submucosa
→ Inflammation in colon only
→ No interspaced healthy areas
→ Goblet cell depletion & crypt abscesses

Crohn’s:
→ Transmural (mucosa + submucosa + muscle + Serosa)
→ Inflammation anywhere in GI tract
→ Areas of inflammation interspaced healthy areas
→ Skip Lesions (Cobblestone appearance)

54
Q

Gastritis Causes + Risks

A 
Causes:
→ Mucosal ischemia 
→ H. pylori 
→ Aspirin I NSAIDs
→ Autoimmune gastritis

Risks:

  • Diabetes
  • Travel + alcohol + old age
  • NSAIDs / Aspirin
  • Stress/ Autoimmune
55
Q

Gastritis Symptoms

A
  • Epigastric pain
  • Diarrhoea
  • Indigestion
  • vomiting & Nausea
  • Fever & Malaise
  • Dehydration
56
Q

Gastritis Investigations

A

If pylori = Stool antigen test or urea breath test
Gold = Endoscopy

  • Faecal occult blood
  • C-Reactive Protein blood test
57
Q

Gastritis Treatment

A

Mild:
Fluid Intake
Small non fatty meals
Antimotility agents

Moderate/ Severe:
If NSAID/ Aspirin cause = PPl / H2 receptor antagonist
If H. Pylori cause = Clarithromycin + Amoxicillin + Omeprazole
If Campylobacter cause = Clarithromycin

58
Q

If Gastritis returns?

A
  • Miss work until 48 hrs after last diarrhoea
  • No swimming for 2weeks after diarrhoea
  • E. coli - do 2 negative stool samples over 24 hrs
59
Q

Peptic + Duodenal ulcer Pathology

A

Peptic ulcers = Break in epithelial cells Penetrating down to muscalaris mucosa → fibrous base & inflammatory cells increase.

Duodenal ulcers = Brunners gland hypertrophy - reduce acidity of duodenum

Affects gastroduodenal artery

60
Q

Peptic & Duodenal Ulcer causes

A
  • Prolonged NSAID & Aspirin use
  • H. pylori = Urease + Protease
  • Zollinger Ellison syndrome = Gastric acid hypersecretion + Tumour of pancreas + Peptic ulcer
61
Q

Peptic & Duodenal ulcer symptoms

A
  • Epigastric pain
  • Peptic ulcer = Pain when eating & goes after 2-3 hrs
  • Duodenal ulcer = Pain reduces when eating & comes after 2-3 hrs
  • Bloating
  • Nausea + Vomiting
62
Q

Peptic & Duodenal ulcer complications

A
  • Bleeding thus hypovolaemic shock
  • Perforation
  • Resp. distress → Sepsis + air under diaphragm
63
Q

Peptic & Duodenal ulcer Investigation

A

Peptic:
Endoscopy with biopsy

Duodenal:
urea breath test or Faecal antigen test
2 weeks without PPI
4 weeks without antibiotics

64
Q

Peptic & Duodenal Treatment

A
  • Stop alcohol & smoking
  • Stop NSAIDs
  • PPI or H2 antagonist
  • H. pylori = Clarithromycin + Amoxicillin + Omeprazole
65
Q

GORD Pathology & Risk

A

Pathology:

  • Inflammation - Scarring - oesophageal Stenosis
  • Risk of neoplasia

Risk:
→ Barrett’s Oesophagus
→ Zollinger - Ellison Syndrome
→ Hiatal hernia - lowers LOS pressure = increases reflux

66
Q

GORD symptoms

A
  • Regurgitation
  • Dyspepsia & Dysphagia
  • Nocturnal asthma
  • worse when lying flat
67
Q

GORD Investigations

A

Therapeutic challenge = Give PPl
Gold - Oesophageal manometery
X- Ray with barium
Serum gastrin

68
Q

GORD Treatment

A 
PPl  (Lanzoprazole) for 1mnth
H2 antagonist (ranitidine)
Gold = Anti -reflux surgery (laparoscopic fundoplication)
- Antacids = neutralise acid
- Prokinetic medication
- GABA agonist baclofen
69
Q

Achalasia + Investigations + Treatment

A

Lower oesophageal sphincter won’t relax so food & liquid can’t pass into Stomach

Ix = Endoscopy / Barium swallow

Tx = Isosorbide dinitrate or Nifedipine or Veramipril
Gold - Surgery → pneumatic dilation

70
Q

Mallory- Weiss Tear (M-W-T) Risk

A
  • Alcohol-binge drinking
  • Chronic cough
  • Weight lifting
  • Bulimia
71
Q

M-W-T Symptoms

A
  • Haematemesis
  • Melaena
  • Hypovolaemic shock
72
Q

M-W-T Treatment

A
  • Resus
  • Antiemetic
  • PPI
73
Q

Appendicitis & Causes

A

= Inflammation of Appendix

  • obstruction
  • Faceolith
  • Pinworm infection
74
Q

Appendicitis Pathology

A
  • Blockage= backed-up fluid & mucus → Increased pressure → Compresses nerves + blood vessels → Ischemia & Necrosis
  • Bacteria= (E. Coli) - WBCC increases
  • Necrosis= no mucus secretion - more bacterial growth
75
Q

Appendicitis Symptoms

A
  • Umbilical pain - migrates to RLQ
  • Rebound tenderness - McBurney’s Point = 2/3 between umbilicus from ileac crest
  • Worse on coughing
  • Vomiting & Low grade fever
76
Q

Appendicitis Sign

A
  • Rosvings sign - Pressing in LLQ causes pain in RLQ
  • Obturator sign
  • Psoas sign
77
Q

Appendicitis Investigations

A
  • CT/ US
  • Bloods → WBC + CRP + high ESR
  • Pregnancy test
78
Q

Appendicitis Treatment

A
  • Laparoscopic Appendectomy
  • Antibiotics
  • Drain abscesses
  • Fluids
79
Q

H. Pylori & Risk

A

Gram -ve bacilli with flagella
Produces urease which makes ammonia → damages gastric mucosa

Risk:
- No clean water

80
Q

H. Pylori Causes

A
  • Gastritis
  • peptic ulcer
  • H. Pylori + Low gastric acid = Peptic/ Gastric cancer
  • H. Pylori + High gastric acid = Duodenal ulcer
81
Q

H. Pylori Symptoms

A
  • Ache /burning pain
  • Abdo pain - worse when stomach is empty
  • Bloating, weight loss & nausea
82
Q

H. Pylori Investigations

A
  • Urea breath test
  • Stool test
  • Endoscopy
  • Blood test
83
Q

H. Pylori Treatment

A

2 Antibiotics & PPl

Clarithromycin + Amoxicillin + Omeprazole

84
Q

Oesophageal Cancer Risks

A 
A = Achalasia
B = Barret's Oesophagus
C = Corrosive oesophagus
D = Diverticulitis
E = Esopheal web
F = Family Hx
85
Q

Hemorrhoids

Sx:
Tx:

A

Swollen veins in anus & lower rectum.
Internal= Painless bleeding, can prolapse
External= Painful, form at anal opening

Sx: Bright red bleeding, Pain

Tx: Stool softeners, high fibre diet, band ligation

86
Q

C.diff.

A
  • Occurs in hospital environment - due to contact
    -Due to C. antibiotics
    → watery diarrhoea
    → fever
    → Malaise
  • Treat with vancomycin
87
Q

Barrett’s Oesophagus cell change

A

Metaplasia

Simple columnar epithelium with goblet cells

88
Q

Dyspepsia

Sx

Ix

Tx

A

Epigastric Pain, Early satiation

Sx: Reflux when lying flat, Heartburn, Bloating

Ix: Stool culture, Blood test, Urea test

Tx: Dietary manage., Antidepress. (Citalopram)

89
Q

Oesophageal varices
Sx:
Ix:
Tx:

A

Sx: vomiting blood, abdo. pain, Spider naevi, yellow sclera

Ix: Blood test = Raised ALT, AST & ALP, high bilirubin & creatinine

Tx: Band ligation, Antihypertensives

90
Q

Diarrhoea types

A
  • Secretary
  • Osmotic
  • Exudative
  • Desentery
91
Q

Haematemesis from ruptured Oesophageal varices

Sx:

Tx:

A

Vomiting large volumes of blood.

Tx: IV Terlipressin

IV Somatostatin it contraindicated

Phase 2a Revision (9 decks)

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