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Kyla's Phase 2a Flashcards > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

Define Crohn’s

A

Transmural granulomatous inflammation - affecting any part of the GI tract

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2
Q

Genetic mutation that is a risk factor for Crohn’s

A

NOD2 gene

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3
Q

What is the inflammatory bowel disease?
Macroscopic appearance of skip lesions, cobblestone appearance (due to ulcers)
Microscopic appearance of, transmural, non-caseating granumolmas and goblet cells

A

Crohn’s disease

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4
Q

What mneumonic is used for Crohn’s disease?

A

N – No blood or mucus (less common)

E – Entire GI tract

S –“Skip lesions” on endoscopy

T – Terminal ileum most affected andTransmural (full thickness) inflammation

S – Smoking is a risk factor (don’t set the nest on fire)

Crohn’s is also associated with weight loss, strictures and fistulas.

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5
Q

Mouth ulcers are associated with which IBD?

A

Crohn’s

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6
Q

Name some extra-intestinal featires of Crohn’s

A
  • Erythema nodosum
  • Anal fissures
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7
Q

Pain associated with Crohn’s

A

RLQ abdominal pain (ileum)
(UC is typcially LLQ)

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8
Q

First line and gold-standard test for Crohn’s

A
  • 1st: Faecal calprotectin (indicates IDB)
  • Gold: Endoscopy (OGD or colonoscopy) + biopsy
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9
Q

Differential diagnosis for Crohn’s

A

Salmonella spp
Chronic diarrhoea
UC

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10
Q

First and second line management for inducing remission in Crohn’s

A

1st: Oral prednisolone or IV hydrocortisone
2nd: Infliximab (anti-TNF), methotrexate, or azathioprine

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11
Q

What drug is used to maintain remission in Crohn’s?

A

Immunosuppressants - Azathioprine

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12
Q

Surgical options for Crohn’s

A

Distal ileum resection (prevent further flares)
Treat secondary strictures and fistulas

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13
Q

Complications of Crohn’s disease

A
  • Intestinal obstruction
  • Anaemia (malabsorption)
  • Malignancy
  • Short-bowel syndrome
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14
Q

Common presenting symptos of Crohn’s

A
  • Chronic diarrhoea
  • Weight loss
  • RLQ pain abdo pain - mimicking acute appendicitis
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15
Q

Define UC

A

Inflammatory (continuous) condition of the colon mucosa (up to the ileocaecal valve)
(Ulvers from along lumen of intestine)

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16
Q

Age of presentation for UC

A

15-30

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17
Q

What drug is a risk factor for Crohn’s and UC?

A

NSAIDs!

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18
Q

Smoking is protective for which IBD?

A

UC
(Useful Cigarettes)

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19
Q

What part (microscopic) of the bowel does UC effect?

A

Mucosa (does not go through the full wall of the bowel)

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20
Q

Which IBD presents with non-caseating granulomas and which has no granulomata?

A

Crohn’s = non-caseating gramulomas
UC = no granulomas

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21
Q

Describe the macroscopic and microscopic features of UC

A
  • Macroscopically
    • Continuous inflammation (no skip lesions)
    • Ulcers
    • Pseudo-polyps
  • Microscopically
    • Mucosal inflammation
    • No granulomata
    • Depleted goblet cells
    • Increased crypt abscesses
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22
Q

What mneumonic is used to describe UC?

A

Ulcerative Colitis (remember U – C – CLOSEUP)

C–Continuous inflammation

L–Limited to colon and rectum

O–Only superficial mucosa affected

S–Smoking is protective

E–Excrete blood and mucus

U–Useaminosalicylates

P–Primary Sclerosing Cholangitis

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23
Q

Patient presents with diarrhoea with blood +
mucus, LLQ abdominal pain, feels like their bowels aren’t empty after passing stools and has clubbing and a tender distended abdomen O/E. Diagnosis?

A

UC

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24
Q

First line tests for UC

A
  • Faecal calprotectin
  • pANCA = positive
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25
Q

Gold standard/diagnostic test for ulcerative colitis

A

Colonoscopy + biopsy

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26
Q

Which IBD is typically positive and negative for pANCA?

A
  • Crohn’s: Negative
  • Ulcerative colitis : Positive
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27
Q

What does a biopsy sample for UC show?

A

Crypt abscesses
Mucosal ulceration only

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28
Q

Differential diagnosis for IBD

A
  • The other type of IBD
  • IBS
  • Other cause of diarrhoea (salmoella, rotavirus)
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29
Q

Give the first and second line management for inducing remission for mild-moderate UC

A
  • First line: Aminosalicylate (mesalazine oral or rectal)
  • Second line: Corticosteroids (prednisolone)
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30
Q

Give the first and second line management for inducing remission for severe UC

A

First line: Hydrocortisone
Second line: IV ciclosporin

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31
Q

Managment for maintaing the remission of ulcerative colitis

A

Aminosalicylate (mesalazine oral or rectal)
Azathioprine

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32
Q

Which IBD involves the depletion of goblet cells?

A

Ulcerative colitis

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33
Q

When a panproctocolectomy (removal of colon and rectum) performed?

A

Curative surgery for UC. Patient left with ileostomy or ileo-anal anastomosis (j-pouch)

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34
Q

Name some complications of UC

A
  • Inflammatory pseudopolyps
  • Colic adenocarcinoma
  • Benign stricture
  • Primary sclerosing cholangitis (PSC)
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35
Q

What can relieve IBS pain?

A

Defecation and passing wind

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36
Q

What exacerbates IBS?

A

Stress, food, gastroenteritis, menstruation

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37
Q

Name a couple causes of IBS

A
  • Psychosocial - stress, anxiety
  • GI infcetion - gastroenteritis
  • Eating disorders
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38
Q

Describe the pathophysiology of IBS

A
  • Dysfunction in the brain-gut axis results in disorder of intestinal motility and/or enhances visceral sensitivity
  • Recurrent abdominal pain with** NO inflammation**
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39
Q

Typical patient with IBS

A

Young female with history of anxiety

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40
Q

Define tenesmus

A

Sensation of incomplete bowel emptying

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41
Q

Young female patinet presents with mucus in stools, change in stool frequency and consistency, diahhorea tenesmus, bloating, pain relieved after going to the toilet. Diagnosis?

A

Irritable Bowel Syndrome

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42
Q

Patient presents with abdo pain, mucus in stool and change in bowel habits. Faecal calprotectun and anti-TTG antibodies are both negative and colonoscopy shows nothing remarkable. Diagnosis?

A

Irritable bowel syndrome

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43
Q

What symptoms suggest IBS?

A

**Abdominal pain / discomfort:

  • Relieved on opening bowels, or
  • Associated with a change in bowel habit**

AND 2 of:

  • Abnormal stool passage
  • Bloating
  • Worse symptoms after eating
  • PR mucus
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44
Q

Differential diagnosis for IBS?

A

Coeliac disease
Lactose intolerance
(Worsen on eating)

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45
Q

Lifestyle changes for IBS

A
  • Limit caffeine and alcohol
  • Low FODMAP diet
  • Regular small meals
  • CBT
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46
Q

First and second line management for IBS

A
  • 1st: Loperamide (for diarrhoea); laxatives (constipation), antispamodics (hyoscine butylbromide)
  • 2nd: Tricyclic antidepressants (amitriptyline orally)
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47
Q

Complications of IBS?

A
  • Diverticulosis
  • Depression
  • Sleep disorders
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48
Q

Define coeliac disease

A

Autoimmune condition
Exposure to gluten causes an autoimmune reaction that causes inflammation in the small bowel

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49
Q

When does coeliac disease usually develop?

A

Infancy (after weaning on to gluten-containing foods)

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50
Q

Name the two autoantibodies present in coeliac disease?

A

Anti-TTG (anti-transglutaminase)
Totally Terrified of Gluten
Anti-EMA (anti-endomysial)

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51
Q

What part of the bowel is affected (inflammed) in coeliac disease?

A

Small bowel (esp. jejunum)

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52
Q

Describe the microscopic changes in the small bowel in coeliac disease

A
  • Villus atrophy
  • Crypyt hypertrophy
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53
Q

Signs of coeliac disease

A
  • Failure to thrive in young children
  • Wt loss
  • Mouth ulcers
  • Anaemia/nutritional deficency
  • Dermatitis herpertiformis (itchy blistering skin rash - typically on the abdomen)
  • Steatorrhoea
  • Diarrhoea
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54
Q

What diet does a patient need to stick to whilst being investigated for coeliac disease?

A

Gluten-containing diet

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55
Q

Name the genetic associations with coeliac disease

A

HLA-DQ2 gene (90%)
HLA-DQ8 gene

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56
Q

First line and gold-standard tests for coeliac disease

A
  • 1st: Check for IgA deficiency, then raised Anti-TGG
  • Gold-standard: Endosocopy + duodenal biopsy (crypt hypertrophy + villous atrophy)
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57
Q

What test can monitor disease activity in coeliac disease?

A

Anti-TTG

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58
Q

Management of coeliac disease

A

Gluten-free diet (no barley, wheat or rye)
Dietitian (correct vitamin deficiencies)

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59
Q

Presentation of diarrhoea and failure to thrive, iron-deficiency anaemia and osteoporosis. Possible diagnosis?

A

Coeliac disease

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60
Q

Complications of coeliac disease

A
  • Vitamin deficiency
    • Steatorrhea, night blindness, bruising, osteoporosis
  • Anaemia
  • Osteoporosis
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61
Q

What is gastritis>

A

Inflammation of the stomach lining
(presence of gastric mucosal inflammation)

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62
Q

Most common cause of gastritis?

A

Helicobacter pylori infection

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63
Q

Causes of gastritis

A
  • H. pylori infection
  • Autoimmune gastritis (cause of pernicious anaemia)
  • Aspirin + NSAIDs
  • Crohn’s

Pernicious anaemia = low RBCs due to low B12

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64
Q

Patient presents with dyspepsia, epigastric pain and vomiting. Possible daignosis?

A

Gastritis

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65
Q

Tests for gastritis

A
  • H. pylori urea breath test
  • H. pylori faecal antigen test
  • Endoscopy + biopsy + histology
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66
Q

Differential diagnoses for gastritis

A
  • Peptic ulcer disease
  • Gastro-oesophageal reflux disease (GORD)
  • Non-ulcer dyspepsia
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67
Q

Treatment for gastritis

A

CAP
C-Clarithromycin
A-Amoxicillin
P-PPIs e.g. omeprazole

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68
Q

Complications of gastritis

A
  • Vitamin B12 deficiency
  • Peptic ulcer disease
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69
Q

Define GORD

A

Reflux of gastric contents into the oesophagus
Through lower oesophageal sphincter
Irritates the oesophagus

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70
Q

Rx of GORD

A
  • Obesity or pregnancy
  • Hitaus hernia
  • Overeating
  • Male
  • Smokung, alcohol
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71
Q

Lining of oesophagus and stomach

A
  • Oesophagus: Squamous epithelium
  • Stomach: Columnar epithelium
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72
Q

Patient presents with dyspepsia, acid regurgitation, retrosternal pain, hoarse voice, painful swallowing, acid taste in mouth and waterbrash. Diagnosis?

A

GORD

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73
Q

What is OGD?

A

Oesophago-gastro-duodenoscopy (endoscopy)

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74
Q

Investigations for GORD

A
  • Usually clinical diagnosis
  • OGD (endoscopy)
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75
Q

Differential diagnoses for GORD

A
  • Biliary colic
  • Peptic ulcer
  • Malignancy
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76
Q

Describe the pain with GORD

A

Retrosternal or epigastric pain

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77
Q

Managent for GORD

A
  • Lifestyle changes (weight loss, stop smoking)
  • Antacids
  • PPIs (Lansoprazole, omeprazole)
  • H2 receptor antagonists (cimetidine)
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78
Q

Name a H2 receptor anatgonist
(Blocks hitsamine receptors on parietal cells - reducing acid release)

A

Cimetidine

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79
Q

Name a complication of GORD (and what it involves)

A

Barrett’s oesopahgus
* Squamous epithelium → columnar epithelium (with goblet cells)
* Risk of progressing to oesophageal cancer - premalignant for adenocarcinoma of oesophagus

**Oesophaeal adenocarcinoma **

Benign oesophageal stricture

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80
Q

What is a peptic ulcer?

A
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81
Q

What is a peptic ulcer?

A

Ulceration of the stoamch (gastric ulcer) or duodenum (dupdenal ulcer)

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82
Q

How do you differentiate between a gastric and duodenal ulcer?

A

Duodenal ulcer = less pain after eating
Gastric ulcer = more pain after eating

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83
Q

Rx for peptic ulcers

A
  • Helcibacter pylori infection
  • NSAID use
  • Smoking
  • Increasing age
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84
Q

Pathiophysiology of peptic ulcer

A

The stomach mucosa = prone to ulceration from:

  • Breakdown of the protective layer (in stomach + duodenum)
  • Increase in stomach acid
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85
Q

Patient presents with epigastric pain, dyspepsia, bloating, haematemesis (coff-ground vomiting), melaena and is nauseous. Possible diagnosis?

A

Peptic ulcer

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86
Q

Key presentations of a peptic ulcer

A
  • Epigastric pain
  • N+V
  • Dyspepsia
  • Iron deficency anaemia (due to constant bleeding)
  • Bleeding causes: haematemesis, ‘coffee ground’ vomiting, malaena
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87
Q

Red flags for cancer

A
  • Unexplained wt loss
  • Anaemia
  • GI bleeding
  • Dysphagia
  • Upper abdominal mass
  • Persistent vomiting
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88
Q

Sx to distinuish between gastritis and peptic ulcer

A

Both have dyspepia and haematemesis
Peptic ulcer pain is better (duodenal) or worse (gastric) after eating

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89
Q

Ix for peptic ulcer disease

A
  • First line: Upper gastrointestinal endoscopu
  • Rapid urease test (for H. pylori)
  • FBC
  • Biopsy (exclude malignancy)
  • Stool antigen test (for H. pylori)
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90
Q

Differential diagnoses for peptic ulcer dsease (PUD)

A
  • Oespophageal cancer
  • Stomach cancer
  • GORD
  • Biliary colic
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91
Q

Managment for peptic ulcer disease

A

Antibiotics for H. pylori and PPIs (CAP)
H2 antagonists (cimetidine)

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92
Q

Complications of peptic ulcers

A
  • Bleeding → anaemia or life-threatening haemorrhage
  • Perforation → peritonitis
  • Scarring + strictures → pyloric stenosis
93
Q

Examination signs of peritonitis

A
  • Localised guarding
  • Rebound tenderness
  • Fever
  • Tachycardia
94
Q

Patient presents with abdominal pain (worse with moving), houlder tip pain. O/E tachycardiac, fever, localised guarding and rebound tenderness. Diagnosis?

A

Peritonitis

95
Q

Where do upper GI bleeds occcur?

A

Oesophagus, stomach, duodenum
(Above the ligament of Trietz)

96
Q

Causes of upper GI bleeds

A
  • Oesophageal varices
  • Peptic ulcers (most common)
  • Mallory-Weiss tear (tear of the oesophageal mucous membrane)
  • Cancers of stomach or duodenum
97
Q

Signs of an upper GI bleed

A
  • Haematemesis
  • **‘Coffee ground’ vomit **
  • Melaena
  • Haemodynamic instability
98
Q

Unsure: Signs of oesophageal varices

A

Jaundice (for ascites in liver disease)

99
Q

Blood tests (first line) for upper GI bleed

A
  • Haemoglobin (FBC)
  • Urea (U&Es)
  • Coagulation (INR, FBC for platelets)
  • Liver disease (LFTs)
100
Q

What two risk assessment scores are used to assess an upper GI bleed?

A

Glasgow Blatchford score
Rockall Score

101
Q

What is the Glasglow Blatchford score used for?

A

Upper GI bleed
(Whether you should send the patient home or not)

Drop in Hb, rise in urea, BP, HR, melaena, syncope

102
Q

What happens to the urea levels during an upper GI bleed?

A

Increases

103
Q

What is the Rockall Score used for?

A

Upper GI bleed assessment:
Used for patients that have had an endoscopy - to calculate their risk of rebleeding + mortality

104
Q

Management of a variceal bleed

A
  • Suspect in patients with a history of liver disease or alcohol excess
  • Antibiotics and Terlipressin reduce moratilty
  • Endoscopy within 12 hours
105
Q

Patient presents with an upper GI bleed with a history of liver disease / excessive alcohol use. Probably cause?

A

Variceal bleed

106
Q

Patient presents with an upper GI bleed with a history of peptic ulcers and uses NSAIDs

A

Non-variceal bleed
(peptic ulcer/Mallory-Weiss tear)

107
Q

Management of a non-variceal bleed

A
  • Suspect in patients with a history of peptic ulcers; using certain medications: NSAIDs, anticoagulant or antiplatelets
  • Consider proton pump inhibitors
  • Endoscopy with 24 hours
108
Q

Variceal bleed

A
  • Suspect with liver cirrhosis
  • Portal hypertension → a lot of pressure backed up behind
  • Give antibiotics → liver cirrhosis damages the immune system → can get septic (bacteria from the GI tract can enter the bloodstream)
109
Q

What is the definitive treatment of an upper GI bleed?
(Variceal and non-variceal)

A

Oesophagogastroduodenoscopy (OGD) → provide interventions to stop bleeding
* Variceal bleed → band ligation
* Non-variceal bleed → cauterisation, clips

110
Q

Zero to Finals management of an upper GI bleed

A

ABATED

  • A–ABCDE approach to immediate resuscitation
  • B–Bloods
  • A–Access (ideally 2 large bore cannula)
  • T–Transfuse
  • E–Endoscopy (arrange urgent endoscopy within 24 hours)
  • D–Drugs (stopanticoagulantsandNSAIDs)
111
Q

What is a Mallory-Weiss tear?

A

Linear mucosal tear occuring at the oesophagogastirc junction
(Caused by a sudden increase in intra-abdominal pressure)

112
Q

A 30 y/o man has been ill recently with a chronic cough and using NSAIDs. He presents to A&E with haematemesis after recurrent coughing. Also complains of abdominal pain and dizziness. His stool is also tar-like. Possible diagnosis?

A

Mallory-Weiss tear

113
Q

First line and diagnostic tests for a Mallory-Weiss tear

A

First line: U&Es (elevated urea in patients with ongoing bleeding)
Gold standrd: Upper GI endoscopy

114
Q

Management for a Mallory-Weiss tear

A
  • Haemorrhage is self-limiting in 80-90% cases (supportive treatment)
  • Active bleeding → therapeutic endoscopy
115
Q

Complications of Mallory-Weiss tear

A
  • Re-bleeding
  • Oesophageal shock/death
  • Hypovolaemic shock/death
  • MI
116
Q

When does a Mallory-Weiss tear normally present?

A

Commonly presents with haematemesis after an episode of forceful or recurrent retching, vomiting, coughing, or straining.

117
Q

What are the differences between a Mallory-Weiss tear and oesophageal varices?

A

Pain → Mallory-Weiss tear (forceful tear
Painless → Oesophageal varices (dilation)

118
Q

What is an oesophageal varices?

A

Painless bleeding of dilated submucosal veins in the lower 1/3 of the oesphagus - due to portal hypertension

119
Q

Where is McBurney’s point located?

A

Lies 2/3 of the way from the umbilicus to the naterior superior iliac spine (ASIS)

120
Q

Peak age and sex of appendicitis?

A

Age: 10-20
M>F

121
Q

Signs O/E that suggest appendicitis?

A
  • Tender mass in RIF
  • Guarding on abdominal palpation
  • Rovsing’s sign
  • Rebound tenderness with palpation
  • Percussion tenderness
122
Q

What is Rovsing’s sign?

A

Palpation of left iliac fossa = causes pain in the right iliac fossa
(Indicative of appendicitis)

123
Q

What do abdominal rebound tenderness + percussion tenderness suggest?

A

Peritonits
(possibly from a ruptured appendix)

124
Q

First line and gold standard investigations of appendicitis?

A
  • First line: Clinical diagnosis, bloods (FBC (rasied WBC) and elevated CRP + ESR), pregnancy test
  • Gold standard: CT abdomen, ultrasound (exclude gynaecological pathology)
125
Q

Differential diagnosis for appendicitis (/RIF pain)?

A
  • Ectopic pregnancy
  • Ovarian cysts
  • Meckel’s diverticulum
  • Perforated ulcer
126
Q

Treatment of appendicitis?

A

Laproscopic appendectomy

127
Q

What is a major complication of appendicitis?
(indicated by rebound tenderness and percussion tenderness O/E)

A

Peritonitis

128
Q

Define diverticular disease

A

When diverticula cause symptoms - e.g. LLQ pain

129
Q

Define diveriticulitis

A

If diverticula become inflamed or infected - causing more severe symptoms

130
Q

Difference between true and false diverticula

A
  • True - all layers
  • False (pseudo) - no muscle layer
131
Q

Is diverticulitis or diverticulosis associated with rectal bleeding?

A

Diverticulosis
(In diverticulitis - the blood vessels are scarred from inflammation)

132
Q

Difference in presentation between diverticulosis and diverticulitis

A

Diverticulosis:
* Rectal bleeding
* Usually no symptoms

Diverticulitis:
* No bleeding
* LLQ pain

133
Q

Which part of the colon are diverticulum most commonly found?

A

Sigmoid colon
(Smallest diameter and higher pressure)
(hence LLQ pain diveriticulitis)

134
Q

Rx for diverticulosis

A
  • Low fibre diet, constipation
  • Increasing age
  • Use of NSAIDs
  • Connective tissue disorders (Marfan, Ehlers-Danlos syndrome)
135
Q

Sx of diverticulosis

A
  • Often asymptomatic
  • Rectal bleeding (fresh blood in stool)
  • Vague abdominal pain, tenderness, bloating, altered bowel habit (diarrhoea/constipation)
136
Q

First line and gold standard of diverticulosis

A
  • First line: Colonoscopy, sigmoidoscopy
  • Gold standard: CT scan
  • (Other: X-ray with barium enema)
137
Q

First and second line managment for diverticulosis

A
  • First: Lifestyle changes (increase fibre intake - avoid constpation), weight loss, smoking cessation
  • Second: Surgical resection (if complicatiopns develop)
138
Q

Define diverticulitis

A

Inflamed diverticula
(Micro-perforation of the diverticulum - causing more severe symptoms)

139
Q

Big risk factor of diverticular disease

A

Low fibre-containing diet

140
Q

Patient presents with a fever, leukocytosis and LLQ pain. The pain comes and goes, worse after eating, defacation and farting eases it. Rectal bleeding and diarrhoea. Possible diagnosis?

A

Diverticulitis
LLQ (often sigmoid colon)

141
Q

Presentation of divericulitis

A
  • LLQ pain
  • Fever
  • Diarrhoea
  • N+V
  • Rectal bleeding
  • Raised inflammatory markers
142
Q

Patient presents with diverticulitis. What first and second line investigations would you perform?

A

First line: Abdominal x-ray (Bowel obstruction + perforation) + bloods (leucocytosis)
Second line: CT abdomen with contrast

143
Q

Management of diverticulitis

A
  • Oral co-amoxiclav (at least 5 days)
  • Analgesia (avoid NSAIDs + opiates)
  • Fluids
  • Surgical resection
  • High fibre diet (prevents recurrence)
144
Q

Complications of diverticulitis

A
  • Ileus, obstruction
  • Peritonitis
  • Fistula communication
  • Lower GI bleeding (bloody stool)
145
Q

What is Meckel’s Diverticulum

A

Congenital malformation of the small bowel (others are large bowel) - that results in a true diverticulum

146
Q

What condition does the ‘rule of 2s’ relate to?

A

Meckel’s Diverticulum
* Symptomatic presentation before 2 years
* 2 inches in length
* 2 types of ectopic mucosa - pancreatic, gastric)

147
Q

Sx of Meckel’s diverticulum

A
  • Melaena
  • Abdominal distension/pain
  • Constipation
  • Vomiting
148
Q

Ix for Meckel’s diverticulum

A
  • FBC
  • Technetium-99m pertechnetate scan (’Meckel’s scan’)
    • Detects gastric mucosa in diverticulum
  • CT scan of abdomen and pelvis
  • Ultrasound of the abdomen
149
Q

Differential diagnoses for Meckel’s diverticulum

A
  • Appendicitis
  • Biliary colic
  • Gastroenteritis
  • IBD
  • IBS
  • Peptic ulcer disease
150
Q

Management of symptomatic Meckel’s diveriticulm

A

Surgical ressection of diverticulum, intestine

151
Q

Complications of Meckel’s diverticulum

A
  • Diverticulitis
  • Perforation of diverticulum
  • Food impaction
  • Peritonitis
  • Peritoneal adhesions
152
Q

What is a volvulus?

A

Twist/rotation of segment of bowel

153
Q

What are abdominal adhesions?

A

Abdomial structures sticking to one another

154
Q

What is an intussusceptio?

A

Part of the intestine that slides into an adjacent part of the intestines

155
Q

Where are bowel obstructions most common?

A

Small bowel
(Small bowel obstruction is more common than large bowel)

156
Q

What pathophysiology occurs when there is a bowel obstruction?

A

Obstruction results in a build up of gas + faecal matter proximal to the obstruction → back pressure → vomiting + dilation of the intestines proximal to the obstruction

157
Q

Is a bowel obstruction a medical emergency?

A

Yes - surgical emergency

158
Q

When can ‘third-spacing’ occur?

A

Bowel obstruction
Third-spacing = hypovolaemic shock
The fluid stays in the GI tract not the blood

159
Q

What are the big three causes of bowel obstruction?

A

HAM:
H -Hernias (small bowel)
A - Adhesions (small bowel)
M -Malignancy (large bowel)

160
Q

Causes of a bowel obstruction

A

In the lumen:
* Tumours (carcinoma, lymphoma)

In the wall:
* Tumours
* Crohn’s
* Diverticulitis

From the outside:
* Tumours (disseminated malignancy of peritoneum)
* Adhesions post surgery
* Volvulus

161
Q

What is a closed-loop obstruction?

A

Closed-loop obstruction = a situation where there are two points of obstruction along the bowel; meaning that there is a middle section sandwiched between two points of obstruction.

162
Q

Causes of a closed-loop obstruction

A
  • Adhesions
  • Hernias
  • Volvulus
  • Obstriction in large bowel and a competent Ileocaecal valve
163
Q

Why are closed-loop obstructions so dangerous?

A

Exapand → ischaemia → perforation

164
Q

Patient presents with green bilious vomiting, abdominal pain (diffuse) + distension, and said that he hasn’t passed a stool of fluatulence in a couple of days. Possible diagnosis?

A

Bowel obstruction

165
Q

Gold standard investigation for bowel obstruction

A

Abdomen CT with contrast

166
Q

First line tests for a bowel obstruction

A

Venous blood gas:
* Metabolic alkalosis
* Raised lactate (bowel ischaemia)

U&Es
* Electrolyte imbalances

167
Q

What is the initial management for a bowel obstruction?

A

‘Drip and suck’
- Nil by mouth(don’t put food or fluids in if there is a blockage)
- IV fluidsto hydrate the patient and correct electrolyte imbalances
- NG tubewithfree drainageto allow stomach contents to freely drain and reduce the risk of vomiting and aspiration

168
Q

What is the definitive management for a bowel obstruction?

A

*Laproscopic or laparotomy
* Exploratory surgery
* Adhesiolysis
* Hernia repair
* Emergency resection
* Stent

169
Q

Causes of small bowel obstruction

A
  • Adhesions
  • Hernia
  • Malignancy
  • Crohn’s
170
Q

What does an untreated bowel obstruction lead to?

A

PIN
* Perforation
* Ischaemia
* Necrosis

171
Q

Key presentation of a small bowel obstruction

A
  • Abdominal pain
  • Bloating
  • Vomiting
  • Failure to pass flatus or stool per rectum
172
Q

Pain associated with SBO?

A

Colicky (starts and stops then diffuse)
SBO pain is higher in the abdomen in LBO

173
Q

Investigations for small bowel obstruction

A

Abdominal x-ray or CT
FBC (low haemocrit - indicating blood loss)
U&Es (hypokalaemia)
ABG (metabolic alkosis - vomiting up gastric acid, elevated lactate - indicate poor tissue perfusion)

174
Q

Most common cause of a large bowel obstruction?

A

Colorectal malignancy
Then volvulus

175
Q

First line investigation for large bowel obstruction

A

Digital rectum exam (empty rectum, hard stools and blood).
FBC (low Hb)

176
Q

Complications of bowel obstruction

A
  • Bowel perforation
  • Sepsis
  • Death
177
Q

What type of neoplasm is gastric cancer?

A

Aggresive adenocarcinoma

178
Q

Rx for gastric cancer

A

H. pylori (peptic ulcers)
Smoking
Increasing

179
Q

65 y/o patient presents with constant + severe epigastric pain, weight loss, anaemia, and later develops jaundice

A

Gastric cancer

180
Q

Ix for gastric cancer

A

FBC
OGD + biopsy
CT/MRI, abdomen and pelvis
PET scan

Upper GI endoscopy + biop - showing carcinoma. Staging based on imagaing

181
Q

Differential diagnosis for gastric cancer

A

Peptic ulcer disease

182
Q

Management of gastric cancer

A
  • Nutritional support
  • Surgical resection + chemotherapy combination
183
Q

Complications for gastric cancer

A
  • Metastasis → liver, peritoneum, lymph nodes
  • Weight loss
  • Nutritional deficiency
  • Indigestion (dyspepsia)
  • Osteopenia or osteoporosis
  • Diarrhoea
  • Fatigue
184
Q

What type of neoplasm are oesophageal cancers?

A
  • Squamous cell carninomas (upper + middle third)
  • Adenocarcinomas (lower third + cardia of stomach)
185
Q

Major cause of oesophageal adenocarcinoma

A

GORD

186
Q

Rx for oesophageal cancer

A
  • Oesophageal squamous cancer
    • Smoking
    • Alcohol
  • Oesophageal adenocarcinoma
    • Obesity
  • Achalasia
  • Barrett’s oesophagus
187
Q

Describe the process of Barrett’s oesophagus and oesophageal cancer

A

Chronic exposure to irritants → metaplasia → dysplasia → malignant transformation

188
Q

Define dysplasia

A

Dysplasia = the presence of cells of an abnormal type within a tissue, which may signify a stage preceding the development of cancer.

189
Q

3 Key Sx of oesophageal cancer

A

Dysphagia, weight loss, pain

Dysphagia - difficulty swallowing solids at first → then fluids.

190
Q

Ix for oesophageal cancer

A

OGD + biopsy
CT thorax + abdomen → tumour staging
PET Scan (accuracy for staging, detects metastatic disease)

191
Q

Complications for oesophageal cancer

A
  • Oesophageal obstruction
  • Regurgitation → aspiration → aspiration pneumonia
  • Metastasis
192
Q

Type of neoplasm for colorectal cancer

A

Adenocarcinoma

193
Q

Achalasia

A

An oesophageal motor disorder characterised by a loss of oesophageal peristalsis and failure of the lower oesophageal sphincter to relax in response to swallowing.

194
Q

How does achalasia present?

A
  • Intermittent dysphagia
  • Retrosternal pressure/pain
  • Regurgitation
195
Q

Differentials for generalised abdominal pain

A
  • Peritonitis
  • Ruptured abdominal aortic aneurysm
  • Intestinal obstruction
  • Ischaemic colitis
196
Q

Differentials for RUQ pain

A
  • Biliary colic
  • Acute cholecystitis
  • Acute cholangitis
197
Q

Differentials for epigastric pain

A
  • Acute gastritis
  • Peptic ulcer disease
  • Pancreatitis
198
Q

Differentials for central abdominal pain

A
  • Ischaemic colitis
  • Intestinal obstruction
  • Early stages of appendicitis
199
Q

Differentials for RIF pain

A
  • Acute appendicitis
  • Meckel’s divertiticulitis
  • Ectopic pregnancy
200
Q

Differentials for LIF pain

A
  • Diverticulitis
  • Ectopic pregnancy
201
Q

Family history risk factors for colorectal cancer

A
  • Familial adenomatous polyposis (FAP)
  • Lynch syndrome (hereditary non-polyposis colorectal cancer (HNPCC))
202
Q

Pathological progression of colorectal cancer

A

Normal epithelium → adenoma → colorectal adenocarcinoma → metastatic colorectal adenocarcinoma

203
Q

Old classification for colorectal cancer

A

Duke Stage

204
Q

Name the stages of the Duke Stages

A
  • A - Mucosa only
  • B - Extends into submucosa (muscle wall)
  • C - Regional lymph nodes
  • D - Metastatic disease
205
Q

What are the red flags to consider for colorectal cancer

A
  • Change in bowel habit (usually to more loose and frequent stools)
  • Unexplained weight loss
  • Rectal bleeding
  • Unexplained abdominal pain
  • Iron deficiency anaemia (microcytic anaemia with low ferritin)
  • Abdominal or rectal mass on examination
206
Q

How does right-sided colorectal carcinoma present?

A
  • Usually asymptomatic
  • Iron deficiency anaemia due to bleeding
  • Wt loss, abdominal pain
  • WOMEN MORE LIKELY
  • WORSE PROGNOSIS
207
Q

How does left-sided + sigmoid carcinoma present?

A
  • Change in bowel habit with blood and mucus in stools
  • Diarrhoea
  • Alternation constipation and diarrhoea
  • Thin/altered stool
  • MEN MORE LIKELY
  • BETTER PROGNOSIS
208
Q

Sx of rectal carcinoma

A
  • Rectal bleeding and mucus
  • When cancer grows, it will have thinner stools and tenesmus (cramping rectal pain)
209
Q

First line Ix for colorectal cancer

A
  • Digital rectal examination
  • Double contrast barium enema
  • Faecal immunochemical tests (FIT)

FIT = amount of human Hb in stool (highly specific)

210
Q

Gold standard Ix for colorectal cancer

A
  • Colonscopy + biopsy
  • Sigmoidoscopy (endoscopy of rectum + sigmoid rectum)
  • CT colonography
211
Q

Other Ix for colorectal cancer

A

Staging CT scan
(CT TAP)
Look for metastasis

212
Q

Management options for colorectal cancer

A
  • Adenoma - endoscopic resection
  • Colorectal adenocarcinoma - surgical resection
  • Metastatic colorectal adenocarcinoma - chemotherapy palliative care
213
Q

Main infectious casusative organisms for diarrhoea

A
  • Children → rotavirus
  • Adults → norovirus, campylobacter
214
Q

Antibiotics for induced C. Diff diarrhoea

A

Rule of Cs
* Clindamycin
* Ciprofloxacin (quinolones)
* Co-amoxiclav (penicillins)
* Cephalosporins (particularly 2nd and 3rd generation)

215
Q

Patient presents with watery diarrhoea - what location of the bowel is infected? Infammatory or not?

A

Watery diarrhoea:
* Non-inflammatory
* Proximal small bowel
* Viruses can play a role

216
Q

Patient presents with blood mucoid diarrhoea. What’s happening?

A

Bloody, mucoid diarrhoea:
* Inflammatory
* Colon

217
Q

What does the onset history for diarrhoea mean?

A
  • Acute - viral/bacterial
  • Chronic - parasites and non-infectious
218
Q

Name the characteristic of diarrhoea

A
  • Floating - fat content malabsorption/coeliac
  • Blood or mucus - inflammatroy, invasive, infection, cancer
  • Watery - small bowel infection
219
Q

Infectious causative organisms for food poisoning diarrhoea

A
  • Meat/BBQs - campylobacter
  • Poultry - salmonella
220
Q

3 Stool tests for diarrhoea

A
  • Stool culture
  • Faecal calprotectin
  • Faecal occult blood
221
Q

Blood tests diarrhoea

A
  • FBC
  • Inflammatory markers (FBC/CRP)
  • Blood culture
222
Q

What bacteria causes a rice water diarrhoea?

A

Vibrio cholerae

223
Q

Managment for cholera

A

Doxycycline + fluids

224
Q

Rx for infective diarrhoea

A
  • Foreign travel
  • PPI or H2 antagonist use
  • Crowded area
  • Poor hygeine
225
Q

Diagnosis for infective diarrhoea

A

Diagnosis - 3 or more unformed stools per day plus one of the following:
- Abdominal pain
- Cramps
- Nausea
- Vomiting
- Dysentery

226
Q

What does blood in infective diarrhoea suggest?

A

Bacteria
E. coli + shigella

227
Q

Antibiotics for infective diarhhroea

A

Metronidazole pr oral vancomycin

228
Q

Cancer risk factors for diarrhoea

A
  • Over 50
  • Chronic diarrhoea
  • Weight loss
  • Blood in stool
  • Family history of cancer

Kyla's Phase 2a Flashcards (10 decks)

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