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Phase 2a > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

What is inflammatory bowel disease?

A

A term that describes disorders involving chronic inflammation of the intestines causing malabsorption

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2
Q

What are the types of inflammatory disease?

A

Chrohn’s disease
Ulcerative Colitis

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3
Q

What is Ulcerative colitis?

A

Autoimmune inflammatory condition of the colon mucosa up to the ileocaecal valve. Ulcers form along the lumen of intestine.

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4
Q

What are the risk factors of ulcerative colitis?

A

FHx, jewish, associated with HLAB27 gene,
smoking - PROTECTIVE

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5
Q

What is macroscopic view of ulcerative colitis?

A
  • starts at rectum can progress to ileocaecal valve
    -circumferential and continuous inflammation
    -no skipped lesions
    -ulcers and pseudopolyps in severe disease
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6
Q

What is the microscopic view of UC?

A
  • mucosa only inflamed
    -crypt abcesses
    -depleted goblet cells
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7
Q

What is the presentation of UC?

A

-Pain in LLQ + Tenesmus (rectal defamation pain)
-Bloody mucusy watery diarrhoea
-Extraintestinal:
-erythema nodosum
-uveitis
-PSC - primary sclerosis cholangitis

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8
Q

What is the diagnosis for UC?

A

Test for pANCA
Fecal calprotectin - indicates IBD when raised
Biopsy - mucosal inflammation with crypt hyperplasia
colonoscopy/XR- continuous ‘lead pipe’ sign
Severity of flares. -truelove +witts scoring

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9
Q

What does the biopsy show for UC?

A

mucosal inflammation with crypt hyperplasia

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10
Q

What would the colonoscopy/XR for UC show?

A

continuous/ “Lead pipe sign”

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11
Q

What scoring is used to test the severity of UC?

A

True love and Witts scoring

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12
Q

What is the treatment for UC?

A
  1. Flares = Sulfasalazine and prednisolone
  2. For remission =Azathioprine

3.Biologics = Anti-TNF Infliximab -

Surgery - total/ partial colectomy - curative

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13
Q

What is a complication of UC?

A

Toxic megacolon

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14
Q

What is Crohn’s disease?

A

A transmural, granulomatous inflammation affecting any part of the gastrointestinal tract(usually rectum spared)

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15
Q

what are the risk factors for crohn’s?

A

FHx, jewish, smoking, NOD2 gene

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16
Q

What does chrohns look like macroscopically?

A
  • any part from mouth to anus- most commonly terminal ileum and proximal colon
    -skip lesions
    -cobblestone appearance -ulcers and fissures in mucosa
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17
Q

What does chrohns look like microscopically?

A

-transmural inflammation (all layers of bowel wall)
-granulomas - no caseating
-incraesed chronic inflammatory cells and lymphoid hyperplasia

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18
Q

What is the presentation of crohn’s?

A

-Pain in RLQ
-Malabsorption - B12/folate/Fe deficiency
-Gall/kidney stones
-watery diarrhoea
-apthous mouth ulcers
-uveitis
-erythema nodosum
-spondylarthritis

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19
Q

What is the diagnosis for Crohn’s?

A

pANCA negative
fecal calprotectin high - as IBD
Biopsy/endoscopy/XR
Endoscopy/XR= skip lesions, cobblestones, string sign
Biopsy= transmural inflammation with non caseating granulomas

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20
Q

What is shown on the endoscopy/XR for crohns?

A

skip lesions, cobblestoning/String sign

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21
Q

What does the biopsy show for crohn’s?

A

Transmural inflammation with non caseating granulomas

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22
Q

What is the treatment for crohns?

A
  1. For flares: sulfasalazine and prednisolone
  2. For remission: Azathioprine
  3. Biologics: Anti TNF- infliximab
    Surgery -not curative
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23
Q

What are the complications of crohns?

A

fistula, strictures, accesses, small bowel obstruction

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24
Q

What is Coeliac disease?

A

An autoimmune type 4 hypersensitivity reaction to gluten causing inflammation of the mucosa of the upper small bowel.
HLADQ2 +DQ8 susceptible

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25
Q

What is the pathology of coeliacs?

A

Prolamins in gluten (A-gliadin) is resistant to proteases in the small intestinal lumen.
Binds to IgA and interacts with
tissue transglutaminase.
Interacts with antigen presenting cells via HLA-DQ2 or 8, causing an immune response.
Results in high IgA, IgA anti-ttg and endomysial antibodies

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26
Q

What is the presentation of coeliac disease?

A

-Malabsorption - Fe/B12/Folate feficiency causing anaemia - anaemia Sx (fatigue, angular stomatitis)
-Diarrhoea
-steatorrhoea
-weight loss and failure to thrive
-osteopenia - low calcium absorption
-Dermatitis herpetiformis - rash on knees due to IgA skin deposition

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27
Q

What is the diagnosis of coeliac disease?

A

1st line screening -Serology - anti -ttG, total IgA high
2nd. - EMA high

Gold - diagnostic - Duodenal biopsy; crypt hyperplasia and villous atrophy + epithelial lymphocyte infiltration

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28
Q

What is the treatment for coeliac?

A
  • stop eating gluten (replace vitamins/ mineral deficiency)
    -monitor osteoporosis with deja scans
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29
Q

What is tropical sprue?

A

enteropathy associated with tropical travel, produces similar sprue to coeliac biopsy - crypt hyperplasia and villous atrophy
Treat - Abx

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30
Q

What is irritable bowel syndrome?

A

Functional chronic bowel disorder related to psychology (stress/anxiety); 3 months of GI Sx with no underlying cause. Everything rules out (IBD, coeliac)

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31
Q

What are the 3 types of IBD?

A

IBS - C - constipation
IBS - D - Diarrhoea
IBS - M - mixed of C/D

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32
Q

What is the presentation of IBS?

A

Abdo pain + bloating - relieved from defeacation
Altered stool form/frequency
urgency

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33
Q

What is the diagnosis of IBS?

A

Exclusions:
- exclude coeliac(serology), IBD(fecal calprotectin) and infection (ESR,CRP, blood cultures)

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34
Q

What is the treatment for IBS?

A

1 - conservative =patient education and reassurance
2- moderate IBS-C= laxatives, more fibre
IBS-D=antimotilitydrug - loperamide
3.Severe - TCA- amitriptyline /consider CBT/referal

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35
Q

What is GORD - Gastro - oesophageal reflux disease?

A

Gastric reflux into oesophagus due to low pressure across lower oesophageal sphincter causing oesophagitis.

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36
Q

What are the causes of GORD?

A
  • increase intra-abdominal pressure - obesity/pregnant
    -hiatal hernia (mostly with sliding; LOS slides up through diaphragm
    -Drugs e.g antimuscarinic
    -Scleroderma (LOS-scarred)
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37
Q

What is the pathology of GORD?

A

Low, lower oesophageal sphincter pressure so more potential for free up passage of acid.

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38
Q

What is the presentation of GORD?

A

Heartburn - retrosternal burning chest pain + chronic cough and nocturnal asthma + dysphagia
Worse lying down

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39
Q

What is the diagnosis for GORD?

A

-No red flags - Go straight to treatment - diagnosis is clinical
-Red flags (Dysphagia, heamatemesis, weight loss)
Endoscopy - oesophagitis or barrets oesophagus
Oesophageal manometry - measure LOS pressure and measure gastric acid pH

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40
Q

What is the treatment for GORD?

A
  1. conservative - lifestyle changes (smaller meds, >3hr eating before bed)
  2. PPI - lansoprazole
    Antacids
    Alginates - Gaviscon (symptomatic)
    Surgery- tightening of LOS- Nissan fundoplication
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41
Q

What are the complications of GORD?

A

-Oesophageal strictures: usually 60+ patients, progressively worsening dysphagia
Treat: PPI and oesophageal dilation
-Barrets oesophagus

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42
Q

What is Barrets oesophagus?

A

-10% GORd patients develop barrets, always involves hiatal hernia
-Metaplasia(stratified squamous to simple columnar)–>dysplasia -Adenocarcinoma

-Usually middle aged caucasian male with history of GORD
-Dx- biopsy

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43
Q

What is a Mallory Weiss Tear?

A

Linear Lowe oesophageal mucosal tear due to sudden increase in intraabdominal pressure.

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44
Q

What are the risk factors of Mallory Weiss tear?

A

Alcohol, chronic cough, bulimia, hyperemesis gravidarum (severe N+V in pregnancy)

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45
Q

What would you suggest if the patient had no history of liver disease and pulmonary hypertension and are presenting with haemetemesis?

A

Haematemesis + pul HTN= oesophageal varices rupture

Haematemesis + no HX of liver disease= MWT

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46
Q

What is the presentation of Mallory Weiss tear?

A

Haematemesis (after retching/vomiting HX)
+hypotensive if severe

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47
Q

What is the diagnosis for mallory Weiss tear?

A

Oesophago -gastro duodenooscopy to confirm (Rockall score= for severity of upper GI bleeds)

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48
Q

What is the treatment for Mallory Weiss tear?

A

Most spontaneously heal within 24hr

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49
Q

What is peptic ulcer disease?

A

Punched out round holes from either the stomach or the duodenum.

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50
Q

What’s the most common PUD?

A

Duodenal ulcer

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51
Q

Where is a gastric ulcer?

A

most commonly in the lesser curve

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52
Q

What are the causes of a gastric ulcer?

A

Helicobacter pylori
NSAIDs
Zollinger Ellison syndrome
Gastrin secreting tumour triad:
-pancreatic tumour
-gastric acid hypersecretion
-widespread peptic ulcers

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53
Q

what is the presentation of a gastric ulcer?

A

Epigastric pain
-worse on eating
-better between meals and with antiacids
-typically weight loss

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54
Q

What is the diagnosis of gastric ulcers?

A

If no red flags (55+, haematemesis, anaemia, dysphagia)
- non invasive tests - stool antigen test - for H.pylori/ Urea breath test

If red flags:
-urgent endoscopy + biopsy

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55
Q

What is the treatment for gastric ulcers ?

A
  • stop NSAIDs and if H.pylori positive = triple therapy CAP
    CAP= clarythromycin, Amoxicillin +PPI
    If PUD found - rescope around 6-8weeks later
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56
Q

What are the complications of gastric ulcers ?

A

Bleeding- left gastric artery ruptured

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57
Q

Where is a duodenal ulcer?

A

mostly at D1 and D2 posterior wall

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58
Q

What are the causes of a duodenal ulcer?

A

H.pylori
NSAIDs
ZE syndrome

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59
Q

What is the most common cause of duodenal ulcers?

A

H.pylori

NSAIDs and ZE more applicable to gastric ulcers

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60
Q

What is the presentation of duodenal ulcers?

A

Epigastric pain
-worse between meals
-better with food
-typically weight gain

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61
Q

What is the diagnosis of duodenal ulcers?

A

-If no red flags:
Non invasive testing
-urea breath test
-stool antigen test

-If red flags:
-urgent endoscopy and biopsy (will see brunners gland hypertrophy -more mucus production)

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62
Q

What are the red flags for PUD?

A

Haematemesis
Dysphagia
anaemia
55+

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63
Q

What is the treatment for duodenal ulcers?

A

Stop NSAIDs and if H.pylori - triple therapy CAP
CAP= clarythromycin, amoxicillin , PPI
If PUD found - rescope in 6-8weeks

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64
Q

What is the complication of duodenal ulcers?

A

Bleeding - ruptured gastroduodenal artery

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65
Q

What is gastritis?

A

Mucosal inflammation and injury of stomach

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66
Q

What are the causes of gastritis?

A

Autoimmune (related to pernicious anaemia + anti- IF antibody), H.pylori, NSAIDs, mucosal ischemia + campylobacter + viral

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67
Q

What is the pathology of autoimmune gastritis?

A

Affects fundus part of stomach, causes atrophy of parietal cells

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68
Q

What is the pathology of H.pylori causing gastritis?

A

H.pylori lives in gastric mucus = secrets urease which spilts urea into ammonia and CO2. Ammonia and H+ = ammonium. Ammonium damages gastric epithelium - causing an inflammatory response. Causes increase in gastrin release and decrease in somatostatin.

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69
Q

What is the presentation of gastritis?

A

Epigastric pain with diarrhoea, N+V, indigestion

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70
Q

What is the diagnosis of gastritis?

A

If H.pylori suspected : stool antigen test, urea breath test
Gold standard - endoscopy and biopsy

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71
Q

What is the treatment for gastritis?

A

H.pylori - triple therapy
CAP = clarythromycin, amoxicillin, PPI

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72
Q

What is Appendicitis?

A

Inflamed appendix, usually due to lumen obstruction. Surgical emergency -peak age 10-20

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73
Q

What are the causes of appendicitis?

A

Faecolith (hard solidified faeces), lymphoid hyperplasia, intestinal worms

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74
Q

What is the pathology of appendix?

A

Most commonly appendix occurs because of an obstruction within the appendix. The obstruction results in the invasion of gut organisms (E.coli) and a pressure increases inside appendix, increase in rupture risk.

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75
Q

What is the presentation of appendicitis?

A

Umbilical pain which localises to mcburneys point + rebound tenderness and abdo guarding
-pyrexic
SIGNS
-Rovsing sign - press on RLQ causes Low pain
-Obturator pain -internal rotation of thigh pain
-Psoas - (lying on left side and extending right led = pain)

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76
Q

What are the complications of appendicitis?

A

Periappendiceal abscess

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77
Q

What is the diagnosis of appendicitis?

A

CT abdo and pelvis - gold ST
Preg test- rule out ectopic pregnancy (presents with RIF pain)

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78
Q

What is the treatment for appendicitis?

A

Abx then appendectomy - laparoscopic
-Must drain abscesses - resistant to Abx

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79
Q

What is Diverticular disease?

A

Symptomatic outpouching of colonic mucosa

80
Q

What is diverticulum?

A

An out pouching at perforating artery sites

81
Q

What is diverticulosis?

A

Asymptomatic out pouch

82
Q

What is diverticulitis?

A

Inflammation of out pouch ; infection

83
Q

What is meckel’s diverticulum?

A

paediatric disorder ; failure of obliteration of vitelline duct. Rule of 2s:
-2year old
-2inches long
-2feet from ileoceacal valve
Technetium scan

84
Q

What are the risk factors for diverticular disease?

A
  • low fibre diet
    -ageing
    -obesity
    -increase in colon pressure; copd; chronic cough
85
Q

What is the presentation of diverticular disease?

A

Triad:
-LLQ pain
-constipation
-fresh rectal bleeding

86
Q

what is the diagnosis of diverticular disease?

A

CT abdo/pelvis with contrast - GS

87
Q

What is the treatment for diverticular disease?

A

D-Losis = watch and wait
D-lar disease =bulk forming laxative. surgery is GS
D-Litis = Abx (coamoxiclav) + paracetamol. IV fluid +liquid food. Rarely surgery

88
Q

What are complications of diverticular disease?

A

Obstruction, fistulae, SBP

89
Q

What is intestinal obstruction?

A

Mechanical bowel obstruction, an arrest of onward propulsion of intestinal contents

90
Q

What are the classifications of bowel obstructions?

A

small bowel - most common (60-75% of all cases)
Large bowel -(25-40% of all cases)

91
Q

What are the causes of small bowel obstruction?

A

Adhesions - often surgical - mc
crohns
Strangulating hernias
malignancy

92
Q

What is the presentation of small bowel obstruction?

A

First vomiting then constipations
mild abdo distension +pain
Tinkling bowel sounds
(hyper resonant bowels on percussion)

93
Q

What are the causes of large bowel disease?

A

Malignancy(90%)
Volvulvus - mostly sigmoid colon
Intussusception - bowel telescope in on itself- mc in children

94
Q

what os the presentation of LBD?

A

First constipation , then vomiting
Gross distention and pain
Hyperactive, then normal, then absent bowel sounds

95
Q

What is the diagnosis of bowel obstructions?

A

1st line - XR = dilated bowel loops + transluminal fluid-gas shadows ( fluid and air accumulates in bowels here- diagnostic sign)
LBO - coffee bean sign (if sigmoid volvulus)

GS- CT abdo

96
Q

What is the treatment for bowel obstruction?

A

-Fluid resuscitation
-Nasogastric tube - food and medicine
-antiemetics + analgesia for symptoms
-Abx
-surgery to remove obstruction

97
Q

What is pseudo bowel obstruction?

A

No mechanical obstruction, often a result of post operative state
(symptoms but can’t find anything blocking it)

98
Q

What is diarrhoea?

A

Abnormal passage of loose or liquid stool more than 3 times daily. A presenting symptom with many different diagnosis.

99
Q

What are the types of diarrhoea?

A

-watery
-secretory
-osmotic
-functional
-steatorrhea
-inflammatory

100
Q

What is dysentery diarrhoea?

A

an infection of the intestines that causes diarrhoea containing blood or mucus.E.coli, shigella, salmonella

101
Q

What is acute diarrhoea?

A

<14 days

102
Q

What is chronic diarrhoea?

A

> 28 days

103
Q

What are the causes of diarrhoea?

A

-IBD
-Coeliac
-Hyperthyroidism
-Inflammation and malignancy
-infective
-worms
-Abx
-parasite - giardiasis

104
Q

What are the viral causes of bacteria?

A

rotavirus - mc- <3years old kids
norovirus - adults

105
Q

What are the bacterial causes of diarrhoea?

A

-c.diff
-campylobacter- mc
-e.coli
-salmonella
-cholera

106
Q

How can antibiotics cause diarrhoea?

A

Antibiotics can give rise to antibiotic induced clostridium .difficile diarrhoea
Rule of C’s:
-Clindamycin
-ciprofloxacin
-co-amoxiclav
-cephalosporins

107
Q

What is the diagnosis of diarrhoea?

A

Think Hx, onset, travel, medications
acute, travel - infective
Under 3 = rotavirus
Abx = c.diff
ricewater= cholera
Non infective, longer Hx :
-IBD,coeliac,malignancy, will have signs

108
Q

What is the treatment for diarrhoea?

A

Depends on underlying cause:
viral: self limiting
complication =Dehydration and electrolyte loss = fluids, diuralite
bacteria - metronidazole
anti-motility - loperamide

109
Q

What are the two types of oesophageal cancer?

A

Adenocarcinoma and squamous cell carcinoma

110
Q

What is oesophageal adenocarcinoma?

A

-lower third of oesophagus
-associated with barrets oesophagus

111
Q

What is oesophageal squamous cell carcinoma?

A

-upper 2/3rd of oesophagus
-smoking and alcohol

112
Q

What is the presentation of oesophageal cancer?

A

presents when advanced;ALARMS

113
Q

What does ALARMS stand for?

A

Anaemia
loss of wt
anorexic
recent sudden Sx worsening
Melena/haematemesis
Swallowing- PROGRESSIVE difficulty

114
Q

What would be non progressive difficulty swallowing?

A

Achalasia - DDx
oesophagus has reduced/ no ability to do peristalsis and transport food down

115
Q

What is the diagnosis of oesophageal cancer?

A

GS- OGD + biopsy with barium swallow
CT/PET for staging

116
Q

What is the treatment for oesophageal cancer?

A

medically fit = chemo/ radio +surgery
Unfit = palliative

117
Q

What are the two types of gastric carcinomas?

A

Mostly adenocarcinomas
Type 1: The intestinal type/well differentiated, better prognosis , mc
Type 2: Diffuseundifferentiated , signet ring carcinomas

118
Q

What are the causes of gastric carcinomas?

A

H.pylori
Smoking
CDH-1 mutation (mutated cadherin gene) ;80% risk - type 2
Pernicious anaemia (autoimmune chronic gastritis)
FHX

119
Q

What is the presentation of gastric carcinomas?

A

severe epigastric pain
Anaemia, wt loss, progressive dysphagia
Mets signs:
Jaundice - liver
Krukenberg tumour -ovarian
Lymphatic spread

120
Q

What is the diagnosis for gastric carcinomas?

A

Gastroscopy + biopsy
CT/MRI for staging
PET for mets
Staging=TNM

121
Q

What is the treatment for gastric carcinomas?

A

Surgery
ECF chemo - E – epirubicin. C – cisplatin. F – fluorouracil

122
Q

What are small intestine carcinomas?

A

SI = pretty tumour resistant -1% of all GI tumours
Most are adenocarcinomas
Same Dx and Tx as gastric

123
Q

What is colorectal polyps and cancer?

A

precursor = adenoma or polyp.
Mostly spontaneous and benign
Common with age but can progress to cancers

124
Q

What are two autosomal dominant inherited conditions that can increase the risk of polyps?

A
  1. Familial adenomatous polyposis
  2. Hereditry non polyposis colon cancer
125
Q

What is FAP?

A

Autosomal dominant APC gene mutation: 1000s of duodenal polyps
- inevitably will get colorectal cancer

126
Q

What is HNPC?

A

Autosomal dominat MSH-1 mutation (or MSH-2)- a DNA mismatch repair gene
-rapidly increases progression adenoma–> adenocarcinoma

127
Q

What are the risk factors of colorectal polyps and cancer?

A

Familial inherited genetic predisposition
Adenomas/polyps
Alcohol,smoking,UC

128
Q

What is the pathology of colorectal polyps and cancer?

A

progression:
Norm epithelium - adenomas- colorectal adenocarcinomas- metastatic colorectal adenocarcinoma
Can mets to liver and lung

129
Q

What is the presentation of colorectal polyps and cancer?

A

mostly in distal colon(sigmoid) therefore LLQ pain, bloody mucusy stools(fresh blood; closer to anus)
Tenesmus - if rectal involvement

130
Q

What is the diagnosis of colorectal polyps and cancer?

A

FIT test (feacal occlult)
- screening test for micro blood particles in stool. Done in all 60+ with Fe deficient anaemia and bowel habit change
- suspected cancer pathway is 2 weeks air, if positive fit test a colorectal cancer referral for colonoscopy + biopsy is within 2 week
- GS =colonoscopy + biopsy
Classification - TNM

131
Q

What is the treatment for colorectal polyps and cancer?

A

Surgery - only curative option if no mets + chemo

132
Q

What is dyspepsia?

A

-NOT a disease. A presenting Sx of indigestion

133
Q

What is the presentation of dyspepsia?

A

early satiation
Epigastric pain and reflux
Extreme fullness

134
Q

What are the causes of dyspepsia?

A

often unknown , ‘functional disorder’, maybe related to ulcers

135
Q

What is the diagnosis and treatment of dyspepsia?

A

Endoscopy to find underlying cause

136
Q

What is achalasia?

A

oesophageal dysmotility (impaired peristalsis), LOS fails to relax -rare +idiopathic

137
Q

What is the presentation of achalasia ?

A

Non progressive dysphagia (struggle swallowing on anything) + chesty substernal pain.
Food regurgitation, aspiration pneumonia

138
Q

What is the diagnosis of achalasia?

A

Bird beak on barium swallow
Manometry (measure pressure across LOS) = diagnostic

139
Q

What is the treatment of achalasia?

A

Only surgery curative (balloon stenting)
Drugs that may help pre-surgery = nitrates, nifedipine

140
Q

What is a complication of achalasia?

A

may increase risk of oesophageal squamous cell lung cancer

141
Q

What is ischemic colitis? (Bowel ischaemia?

A

occlusion of a branch of the superior/ inferior mesenteric artery causing ischaemia to watershed areas of the colon. Colon inflamed due to hypoperfusion.

142
Q

What are the causes of IC?

A

Affecting IMA: Thrombosis, Emboli, Low CO2 and arrhythmias

143
Q

What are the most common sites affected by IC?

A

Watershed areas- splenic flexure (mc), sigmoid colon and cecum

144
Q

What is the presentation of IC?

A

LLQ pain + bright bloody stool
+/- signs of hypovolemic shock

145
Q

What is the diagnosis of IC?

A

colonoscopy and biopsy - GS (but only after presentation fully recovered; prevents strictures formation and normal healing)
Rule out other causes - stool sample

146
Q

What is the treatment of IC?

A

Symptomatic - IV fluid + Abx (prophylactic)
Gangrenous (infarcted colon) - only surgery

147
Q

What is a complication of IC?

A

strictures therefore obstruction

148
Q

What is mesenteric ischaemia?

A

Ischaemia of small intestine

149
Q

What is acute and chronic mesenteric ischemia?

A

acute attack -abdo MI
Chronic - longer lasting over months -abdo angiina

150
Q

What are the causes of mesenteric ischameia?

A

Affecting SMA: Thrombosis - mc
Emboli - due to AF

151
Q

What is the presentation of mesenteric ischeamia?

A

Triad:
- Central/RIF acute severe abdo pain
-no abdo signs on exam
-rapid hypovolemic shock

152
Q

What is the diagnosis of Mesenteric ischameia ?

A

CT angiogram
FBC +ABG =persistent metabolic acidosis

153
Q

What is the treatment of mesenteric ischameia?

A

Fluid resuscitation
Abx
IV heparin(thromboembolism)
Infarcted bowel–> surgery

154
Q

What is a complication of Mesenteric ischameia ?

A

SBP - Spontaneous bacterial peritonitis

155
Q

What are the types of GI bacteria?

A

H.pylori
E.coli
C.difficile

156
Q

What is H.pylori?

A

low virulence commensal in GIT
Gram negative

157
Q

What is the pathology of H.pylori?

A
  1. lowers somatostatin
  2. high luminal gastric acid as gastrin incraese
    3.Urease; results in ammonium generation
    4.lowers HCO3 secretion
158
Q

What can H.pylori cause?

A

PUD
Gastritis
Gastric carcinomas

159
Q

What is the diagnosis for presence of H.pylori?

A

Biopsy - stool antigen
C-urea breath test

160
Q

What is the treatment for H.pylori?

A

CAP
clarythromycin, Amoxicillin, PPI

161
Q

What is E.coli?

A

Gram negative
commensal of GIT

162
Q

What are the different strains/serotypes of E.coli?

A

ETEC,EAEC,EPEC –> watery diarrhoea
EHEC–> Bloody diarrhoea
Serotype 0157:H7 –> haemolytic uremic syndrome (haemorrhage diarrhoea + nephrite syndrome)

163
Q

What is the treatment for E.Coli?

A

Amoxicillin

164
Q

What is C.difficile?

A

Gram positive spore forming bacteria

165
Q

What can C.difficile cause?

A

-Mainly induced with Abx -C’s!
Normal GIT flora killed by the C’s Abx and C.dificil replaces these. Results in dangerous severe watery diarrhoea + dehydration and is highly infectous
- causes pseudomembranous colitis

166
Q

What is the treatment for C.dificil?

A

Stop using C’s Abx
Vancomycin

167
Q

What is haemorrhoids (piles)?

A

Swollen veins around anus disrupt anal cushions - part of anal cushions prolapse through tight anal passage

168
Q

What is the most common cause of haemorrhoids?

A

Constipation with straining - anal sex

169
Q

What are the two types of haemorrhoids?

A

Internal and external

170
Q

What are internal haemorrhoids?

A

Originate above internal rectal plexus (dentate line)
Less painful as has much less sensory supply. May feel incomplete emptying

171
Q

What are external haemorrhoids?

A

Originate below dentate line, so painful patients can’t sit down

172
Q

What is the presentation of haemorrhoids?

A

Bright red fresh bleeding and mucusy stool + bulging pain + itchy bum

173
Q

What is the diagnosis of haemorrhoids?

A

DRE for external
Proctoscopy - for internal

174
Q

What is the treatment for haemorrhoids?

A

Stool softener
Definitive : Rubber band ligation

175
Q

What is a perianal abscess?

A

Walled off collections of stool+bacteria around anus

176
Q

What is the mc cause of perianal abscess?

A

Anal sex, causing anal gland infection

177
Q

What is the presentation of perianal abscess?

A

pus in stool +constant pain/tender

178
Q

What is the treatment for a perianal abscess?

A

Surgical removal + drainage - walled off so resistant to oral Abx therapy

179
Q

What is an anal fistula?

A

Abnormal tracks between inside of anus to elsewhere (subcut skin mostly)

180
Q

What are the causes of anal fistulas?

A

typically progress from perianal abscesses - abscess discharges (toxic substances ) aid fistula formation

181
Q

What is the presentation of anal fistula?

A

Bloody/ mucusy discharge - often very visible and painful

182
Q

What is the treatment for anal fistula?

A

Surgical removal and drainage + Abx if infected

183
Q

What is an anal fissure?

A

Tear in anal skin lining below dentate line therefore very painful as strong sensory supply

184
Q

What are the causes of anal fissures?

A

Hard faces
Trauma - childbirth
Crohns/UC

185
Q

What is the presentation of an anal fissure?

A

Extreme defecation pain and very itchy bum (pruritus ANI) and anal bleeding

186
Q

What is the treatment for anal fissures?

A

stool softening ; more fibre; more fluids
Topical creams
Definitive - surgery - but not rlly done

187
Q

What is pilondial sinus/ abscess?

A

Hair follicles get stuck in natal cleft which form small tracts (sinuses)and can get infected (abscesses) - seen in very hairy people

188
Q

What is the presentation of pilondial sinus/abscess?

A

swollen pus filled smelly abscess on bumcrack - visible on exam

189
Q

What is the treatment for pilondial sinus/abscess?

A

surgery and hygiene advice

190
Q

What is Zenker’s Diverticulum (pharyngeal pouch)?

A

some food goes down pouch instead of totally down oeosophagus
Sx:
smelly breath
Regurgitation + aspiration of food

191
Q

What is CMV - cytomegalovirus?

A

causes owl eye colitis on histology - in immunocompromised patients (AIDS defining illness)

192
Q

What is TNM staging?

A

Cancer staging system
T- primary tumour
N- regional lymph nodes
M- metastases

193
Q

What is TX?

A

main tumour cannot be measured

194
Q

What is T0?

A

Main tumour cannot be measured

195
Q

What is T1,2,3,4

A

Refers to the size and extent of tumour

196
Q

What is NX,N0,N1,2,3?

A

NX: cancer in nearby lymph nodes cannot be measured
N0: no cancer in nearby lymph nodes
N1,2,3: Refers to the number and location of nodes that contain cancer

197
Q

What is MX,M0,M1?

A

MX: metastasis cannot be measured
M0: not spread to other pars of the body
M1:Cancer has spread to other parts of the body

Phase 2a (9 decks)

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