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Phase 2a NEW > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

Intestinal obstruction

A

Intraluminal - Tumours (colorectal), lymphomas, gallstones
Wall - Crohn’s disease (inflammation), diverticular disease, tumours, Hirschsprung’s disease (dilated loops of bowel)
Extraluminal - Adhesions (previous surgery), volvulus (sigmoid colon twisted on itself), peritoneal tumour

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2
Q

Crohn’s disease

A 
Anywhere from mouth to anus 
Inflammatory 
Fibrosis 
Cobblestone mucosa
Chronic
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3
Q

Diverticular disease

A

Sigmoid colon
Inflammation
Diverticulitis can lead to peritonitis
Associated with low fibre diet

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4
Q

Hirschsprung’s disease

A 
Dilated colon 
Aganglionic segments (lack of ganglion cells)
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5
Q

Volvulus

A

Sigmoid colon twisted on itself

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6
Q

Intestinal obstruction

A

Mechanical

Paralytic

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7
Q

Small bowel obstruction - Pathophysiology of proximal dilation

A 
Increased secretions
More dilation 
Increased pressure 
Signs - Loss of appetite, N/V
Untreated leads to - Ischaemia, necrosis, perforation
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8
Q

Large bowel obstruction - Pathophysiology

A

Similar to small bowel obstruction
Competent iliocaecal valve - Caecum usual site of perforation
Incompetent iliocaecal valve - Vomiting
Colonic vulvulus

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9
Q

Intestinal obstruction - Symptoms

A 
Anorexia 
N/V
Distension 
Abdo pain 
Altered bowel habits - Constipation, obstipation
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10
Q

Bowel obstruction

A

Small bowel ob more common than large bowel ob

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11
Q

SBO in children - Causes

A

Appendicitis most common

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12
Q

SBO in adults - Causes

A

Malignancy
Crohn’s
Hernia
Surgery adhesions

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13
Q

SBO - Uncommon causes

A

Diverticulitis

Appendicitis

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14
Q

LBO - Causes

A

Colorectal malignancy, volvulus most common

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15
Q

Tumours of the lower gastrointestinal tract

A

Colorectal adenocarcinoma is most common

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16
Q

Colorectal adenocarcinoma - Causes

A

Familial adenomatous polyposis

Hereditary non-polyposis colorectal cancer (HNPCC)

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17
Q

Colorectal cancer - Staging

A

Resection - R0-R2
Spread - Lymph nodes, liver (portal vein drainage - 1st point of drainage from colon)
Dukes - A-D
pTispN0 (-pT1-3pN1-2)

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18
Q

Colorectal adenoma treatment

A

Adenoma - Endoscopic resection
Colorectal adenocarcinoma Surgical resection
Metastatic CAC - Pallitaive chemo

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19
Q

Diarrhoea - Bristol stool chart

A

Type 1-7
Type 1 is hard lumps
Type 4 is smooth and soft
Type 7 is watery

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20
Q

Diarrhoea - Causes

A

Non infective - Neoplasm, inflammatory, irritable bowel, hormonal, anatomical, radiation, chemical
Infective - Bloody (dystentry), non-bloody

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21
Q

Types of transmission

A

Direct - STIs, scabies, viral gastroenteritis (faeco-oral)
Indirect (vector-borne) - Malaria, dengue
Indirect - HepB
Airborne - TB, legionella

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22
Q

Diarrhoea - Causative organisms

A 
Vibrio cholerae 
Escherichia coli 
Norovirus 
Shigella (bloody stools)
Clostrdium difficile 
Campylobacter
Salmonella 
Cryptosporidium
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23
Q

Norovirus

A

Main cause of winter vomitting
Lasts 1-3 days
Causes diarrhoea along with nausea, cramps, headache, fever, chills, myalgia

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24
Q

Clostridium difficile

A

Distributed in soil and digestive tract
Spores resistant to heat, drying and chemicals
Associated with antibiotic use (mostly broad-spec ab)
In hospitalised patients causes diarrhoea and colitis
Spreads by faeco-oral route or through spores in environment
Most symptomatic cases occur in elderly
Cause of most antibiotic-associated diarrhoea

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25
Q

C difficile - Prevention

A

Alcohol hand rubs will not destroy the spores as they are highly resistant to chemicals
Hand washing using soap and water will remove the microorganisms (spores) from the hands

26
Q

C difficile - SIGHT

A 
S-uspect C diff as cause of diarrhoea
I-solate the case
G-loves and aprons
H-and washing with soap and water
T-est stool for toxin
27
Q

C difficile - Management

A 
Control antibiotic usage 
Infection control procedures 
Surveillance 
Metronidazole
/vancomycin 
Fluids to prevent dehydration 
Zinc
Vaccination
28
Q

C difficile - Investigation

A

Stool sample - Toxins

Culture - test stool sample for strain

29
Q

Diarrhoeal disease in children

A

Frequent loose/watery stools
More than 3 times per day
If fluid loss not replaced can lead to death
Causatives - Rotavirus, E.coli, shigella, campylobacter, salmonella, cryptosporidium

30
Q

Coeliac disease

A

Gluten-sensitive enteropathy
Chronic autoimmune enteropathy triggered by ingested gluten in genetically susceptible individuals
V common condition in europe
mostly adults

31
Q

Coeliac disease - Investigations

A

Endoscopy (Upper GI) and duodenal biopsy
Serology - IgA tTG
Histology - Villous atrophy
Test while on a gluten diet otherwise false results!

32
Q

Coeliac disease - Environment+genetics

A

Environment - Gluten

Individual - HLA DQ2/DQ8 molecules expressed, tissue transglutaminase

33
Q

Coeliac disease - Pathophysiology

A

Gluten peptides enter gut lumen
IL15 cytokine promotes lymphocyte growth
Tissue transglutaminase - Gluten peptides have a high affinity to bind to HLA molecules
Tissue transglutaminase then activates CD4 molecules which triggers an immune response

34
Q

Coeliac disease - Presentation

A 
Diarrhoea
Wt loss
Steatorrhoea 
IBS
Dermatitis herpetiformis (blistering of the skin can be watery)
35
Q

Dermatitis herpetiformis

A

Chronic autoimmune blistering skin condition
Usually on elbows and knees, also buttocks and scalp
Cutaneous manifestation of Coeliac
Granular IgA on skin biopsy

36
Q

Coeliac disease - Management

A

Gluten-free diet - Dietitian review

DEXA scan - Osteoporotic risk

37
Q

Gluten

A

Protein found in wheat, barley, oats, rye

Used in bread, cake, cereals, wheat flour

38
Q

Coeliac disease - Complications

A

Osteoporosis

Malignancy

39
Q

Peritoneum - Disease functions

A

Inflammatory and immune responses
Fibrinolytic activity
Pain perception

40
Q

Peritonitis

A

Inflammation of peritoneum

41
Q

Peritonitis - Causes

A

Bacterial - GI
Chemical - bile
Trauma - operative
Ischeamia - strangulated bowel, vascular occlusion

42
Q

Peritoneal infection

A 
GI perforation (ulcer, appendix, diverticulum)
Transmural translocation (pancreatitis, ischaemic bowel, primary bacterial peritonitis)
Exogenous contamination (drains, open surgery, trauma, peritoneal dialysis)
Female genital tract infection - (Inflammatory pelvic disease)
Haematogenous spread (septicaemia)
43
Q

Localised peritonitis - Presentation

A 
Pain
N/V
Fever
Tachy
Localised guarding 
Rebound tenderness
44
Q

Generalised peritonitis - Presentation

A 
Abdo pain
Tenderness
Guarding
Fever
Tachy
Distension 
Absent bowel sounds (due to paralytic ileus)
45
Q

Peritonitis - Investigations

A

Urine dipstick - UTI
Bloods - UEs, FBC (WCC), serum amylase
Aspirate peritoneal fluid
CXR

46
Q

Peritonitis - Management

A 
Fluids
Urinary catheterisation 
GI compression
Antibiotics
Analgesia 
Excision of perforated organ with/without drainage
47
Q

Peritonitis - Special forms

A 
Bile peritonitis 
Spontaneous bacterial peritonitis 
Primary pneumococcal peritonitis 
Tuberculosis peritonitis 
Familial mediterranean fever (periodic peritonitis)
48
Q

Ascites

A

Accumulation of excess serous fluid within the peritoneal cavity
Healthy men - no fluid
Women - up to 20ml
Stage 1-4 (4=large and tense)

49
Q

Ascites - Causes

A

Cirrhosis
Malignancy
Pancreatitis
Cardiac failure

50
Q

Ascites - Presentation

A 
Abdo distension 
Nausea
Loss of appetite
Constipation 
Pain
If cause is liver - Jaunice 
Shifting dullness
51
Q

Ascites - Investigation

A

Underlying cause - LFTs, cardiac function
CT Abdo
Ascitic aspiration - fluid for microscopy, culture and protein content (amylase)

52
Q

Ascites - Treatment

A

Diuretics - Spironaloctone

Drainage - Paracentesis

53
Q

Aspirin

A 
Enteric coated
Inhibits COX2 (prostaglandin synthetase)
54
Q

Malabsorption

A 
Insufficient intake 
Defective intraluminal digestion 
Insufficient absorptive area 
Lack of digestive enzymes
Defective epithelial transport 
Lymphatic obstruction
55
Q

Defective intraluminal digestion

A

Pancreatic insufficiency - pancreatitis, CF
Defective bile secretion (lack of fat solubilisation) - Biliary obstruction
Bacterial overgrowth

56
Q

Coeliac disease - histological key features

A

Villous atrophy

Crypt hyperplasia

57
Q

Lack of digestive enzymes

A

Lactose intolerance - Disaccharidase deficiency

Bacterial overgrowth - Brush border damage

58
Q

Small intestinal bypass/resection

A

Crohn’s disease

Infarcted small bowel

59
Q

Lymphatic obstruction

A

Lymphoma

TB

60
Q

Gastritis and gastroduodenal ulcer - Treatment

A

Aspirin

H2 blocker - Cimetidine

Phase 2a NEW (16 decks)

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