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ΩΩ 2a Bateman - Systems Based > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

WHAT IS HELIOCBACTER PYLORI?

A

Gram negative, curved motile rod, microaerophilic.

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2
Q

What is heliocbacter pylori’s key biochemical feature?

A

Urease positivity-used in testing.

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3
Q

How is heliocbacter pylori spread?

A

Oro-fecal or oral-oral.

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4
Q

What is the pathogenesis of heliocbacter pylori?

A

Adapted to living in gastric mucus Colonises over gastric but not intestinal epithelium.

Induces inflammation

Stimulates increased gastrin

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5
Q

What are some disease associations with heliocbacter pylori?

A

Ulcers.

In the absence of NSAIDS or Zollinger-Ellison syndrome.

Gastric cancer.

Gastric lymphoma.

Oesophageal disease.

Barrett’s oesophagus.

Others.

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6
Q

What are the usual symptoms of heliocbacter pylori?

A

Acquisition usually asymptomatic but may cause nausea and epigastric pain.

Chronic diffuse superficial gastritis

Followed by a period of achlorrydria.

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7
Q

What investigations can you do for HP?

A

Serology

Stool antigen

Urea breath test

Endoscopy with urease test

Histology ± culture

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8
Q

What is the treatment for H.Pylori?

A

Omeprazole

Amoxicillin

Clarithromycin OR metronidazole

IF penicillin allergic then metronidazole for amox

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9
Q

WHAT IS PERITONITIS?

A

Inflammation of peritoneum.

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10
Q

What are the causes of peritonitis?

A

Perforation of GI tract i.e. trauma

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11
Q

What are the symptoms of peritonitis?

A

Pain

Rebound tenderness

Guarding reflex

Fever

Increase in WBC

Shoulder tip pain in sepsis

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12
Q

What are the investigations of peritonitis?

A

Erect CXR - air under diaphragm.

USS/CT

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13
Q

How can you treat peritonitis?

A

IV fluids

Antibitoics
Metronidazole for anaerobes and cephalexin for aerobes

Electrolytes

Surgery laparotomy

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14
Q

WHAT IS THE DEFINITION OF INTESTINAL OBSTRUCTION?

A

Blockage to the lumen of gut Intestinal

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15
Q

What are some causes of bowel obstruction?

A

Adhesions

Hernias

Tumour

Crohn’s

Volvulus

Gallstone Ileus

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16
Q

How is bowel obstruction classified?

A

According to site - e.g. small vs large intestine

Extent of luminal obstruction

Mechanical / True ( intraluminal / extraluminal)

Paralytic (Pseudo obstruction)

Simple Closed loop Strangulation Intussusception

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17
Q

WHAT ARE THE CAUSES OF SMALL BOWEL OBSTRUCTION?

A

tumours

intussusception

gallstone ileus

impacted faeces

meconium

bezoars

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18
Q

What are the symptoms of small bowel obstruction?

A

abdominal pain, colicky, i.e. returns to normal periodically. Felt in mid-abdomen. Need to know site, radiation, duration and relieving factors.

no flatus; constipation is present

distention, early in the course of the illness if the obstruction is high

vomiting, again earlier in the course if the obstruction is relatively proximal in the bowel

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19
Q

What are the investigations for small bowel obstruction?

A

blood urea and electrolytes

white cell count

  • *radiology:**
    supine: obstructive picture of dilated small bowel

sitting: multiple air/fluid levels in obstruction

to distguish the site:

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20
Q

What is the treatment for small bowel obstruction?

A

Drip and suck
A nasogastric tube is placed in small bowel obstruction or if the patient is vomiting

Nil by mouth and given intravenous fluids

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21
Q

WHAT ARE THE CAUSES OF LARGE BOWEL OBSTRUCTION?

A

The principal cause of large bowel obstruction is carcinoma, which together with diverticulitis accounts for 90% of cases.

Colonic volvulus is a rare cause of obstruction

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22
Q

What are the symptoms of large bowel obstruction?

A

Present quite late with:

  1. Faecel vomiting
  2. Weight loss
  3. Appetite loss.
  4. Colicky abdominal pain.

Signs include:

  1. Succussion splash
  2. Dehydration
  3. Mass due to the tumour, either in the epigastrium or in the lymph nodes
  4. Hepatomegaly
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23
Q

What is the treatment for large bowel obstruction?

A

Drip and suck
A nasogastric tube is placed in small bowel obstruction or if the patient is vomiting

Nil by mouth and given intravenous fluids

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24
Q

What are the indications for immediate surgery of a bowel obstruction?

A
  1. Crescendo pain
  2. Localised peritonism, implying perforation or ischaemia
  3. Complete colonic obstruction with competent ileocaecal valve and caecum dilated to greater than 8cm
  4. “Closed loop” seen radiologically
  5. Obstruction occurring as a result of hernial incarceration
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25
Q

WHAT IS A VOLVULUS?

A

A twist / rotation of segment of bowel

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26
Q

What are the types of volvulus?

A

Sigmoid (most common)

Cecal

Midgut

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27
Q

What is the cause of a sigmoid volvulus?

A
  1. Pregnancy
  2. Middle aged and eldery constipation
  3. Adhesions
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28
Q

What can cause a cecal volvulus and what can cause a midgut volvulus?

A

Same as sigmoid, mesenteric join loose

Abnormal fetal development for midgut

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29
Q

What can happen to a volvulus?

A

Can twist and stop blood flow to that part

Can release bacteria into body

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30
Q

What are the symptoms of a volvulus?

A

Colicky abdominal pain

Vomiting (earlier with small bowel)

Constipation (earlier with large bowel).

Distension and tinkling bowel sounds.

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31
Q

What are the tests for a volvulus?

A

Abdo X-ray

Barium enema
Bird’s beak

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32
Q

What is the treatment for a volvulus?

A

Sigmoidoscopy

Endoscopy

Surgery

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33
Q

What is a Hartmann’s procedure?

A

Hartmann’s procedure is performed when a carcinoma of the rectum is found to be unresectable either due to local invasion or because the patient is unfit for a major resection

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34
Q

What is Paul-Mikulicz procedure?

A

A Paul-Mikulicz procedure is used to treat obstructed colonic carcinoma, volvulus or localized diverticular disease

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35
Q

WHAT IS A HERNIA?

A

Protrusion of organ or tissue out of the body cavity in which it normally lies

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36
Q

What are some causes of hernias?

A
  1. Age
  2. Chronic cough
  3. Trauma damage
  4. Failure of abdo wall to close properly in womb
  5. Constipation
  6. Heavy weight lifting
  7. Pregnancy
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37
Q

What are the different meanings for these?

Irreducible

Reduction

Incarceration

Obstructed

Strangulated

A

Irreducible= hernia cannot be pushed back into the right place

Reduction = pushing tissue/organ back into place

Incarceration = contents of hernialsac are stuck inside by adhesions

Obstructed = bowel contents cannot pass through them

Strangulated = if ischaemic occurs

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38
Q

What are the different types of hernia?

A

Hiatal

Inguinal

Femoral

Incisional (after surgery)

Umbilical (<6m, normally corrects itself)

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39
Q

What is the most common hernia and why?

A

Inguinal hernia

70%

More common in MEN because after testicles descend through canal after birth the canal doesn’t always close properly so is weakened

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40
Q

What is a direct inguinal hernia?

A

Protrudes DIRECTLY into inguinal canal

Medial to inferior epigastric vessels

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41
Q

What is an indirect inguinal hernia?

A

Protrudes through internal inguinal ring

Lateral to inferior epigastric vessels

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42
Q

What is a hiatus hernia?

A

Part of stomach herniates through oesophageal hiatus of diaphragm

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43
Q

How does a hiatal hernia occur?

A

Sliding
GO junction slides through hiatus and lies above diaphragm

Para-oesophageal hernia
Gastric fundus rolls up through hiatus alongside oesophagus, GO junction remains below diaphragm

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44
Q

What are the symptoms of a sliding hernia?

A

None unless gastric oesophageal reflux occurs

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45
Q

What are the symptoms of a para-oesophageal hernia?

A

Serious risk of complications (gastric volvulus, bleeding)

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46
Q

What are the investigations for a hernia?

A

Made clinically with history and examination

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47
Q

What are the treatments for hernias?

A

May require surgical repair

Reducing the hernia can prevent strangulation from occurring

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48
Q

WHAT IS DIVERTICULOSIS?

https://www.youtube.com/watch?v=TL9_WKuNfu0

A

Little pouches at the side of the gut

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49
Q

What is diverticular caused by?

A

High pressure within the lumen pushes part of the intestine out

Classically, diverticular disease is believed to occur as a result of deficiency of dietary fibre.

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50
Q

Where do most diverticulums occur?

A

Sigmoid colon

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51
Q

What causes incresed risk of diverticulosis?

A

Low fiber foods leads to constipation

Fatty foods and red meat

Marfan’s syndrome

Ehlers-danlos syndrome

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52
Q

WHAT IS DIVERTICULAR DISEAESE?

A

Diverticula + complications e.g. infection, hemorrhage, infection

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53
Q

What is the symptoms of diverticular disease

A

Usually no symptoms

Sometimes stomach pain and bleeding

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54
Q

What can happen if a outpouching ruptures?

A

Can form a fistula

Connection between it and another organ

Most commonly the bladder

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55
Q

What is the tests for diverticular disease?

A

Diagnosis of exclusion

Contrast CT Abdo Pelvis

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56
Q

What are the treatment options for diverticular disease?

A
  1. Diet
    More fibre
  2. Smooth muscle relaxants
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57
Q

WHAT IS DIVERTICULITIS?

A

Inflammation of diverticula

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58
Q

How can a diverticulosis become a diverticulitis?

A

Inflammation

Through high pressures erroding the wall
OR
Lodged fecalith

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59
Q

What are the symptoms of acute diverticulitis?

A

LIF pain

Fever

Abdoguarding

Tachycardia (similar to appendicitis but on the left)

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60
Q

What are the symptoms of chronic diverticulitis?

A

Chronic diverticulitis exactly mimics the local clinical features of carcinoma of the colon:

  1. Mucus/bloody diarrhoea alternating with constipation
  2. Which progresses to large bowel obstruction with
  3. Vomiting
  4. Distension
  5. Colicky abdominal pain
  6. Constipation
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61
Q

What are the tests for diverticulitis?

A
  1. Diagnostic - Contast CT Abdo Pelvis
  2. Bloods (ESR, CRP)
  3. USS
  4. Sigmoidoscopy
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62
Q

What is the treatment of diverticulitis?

A

Increasing dietary fibre and physical exercise may improve symptoms

Generally treated with bed rest

IV fluids, analgesics

IV antibiotics - for example cefuroxime and metronidazole - and antispasmodics

Surgical removal - not usually done

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63
Q

WHAT ARE THE RISK FACTORS FOR OESOPHAGUS CANCER?

A

Two main risk factors

gastro-oesophageal reflux

obesity

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64
Q

What is the most common cancer found in oesophageal cancer?

A

Squamous cell carcinoma (SCC) upper 2/3rds

Adenocarcinoma lower 1/3rd

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65
Q

What is the staging for oesophageal cancer?

A

TNM

T = primary tumour

N = lymph nodes

M = metastisis

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66
Q

What are the symptoms of oesophageal cancer?

A

Dysphagia

Weight loss

Anorexia

GI Bleeding

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67
Q

What are the investigations for oesophageal cancer?

A

Endoscopy

in patients with ALARM symptoms

Aged 55 or older with unexplained dyspepsia

Barium oesphagography

CT
Staging

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68
Q

What is the treatment for oesophageal cancer?

A
  1. Surgery
  2. Chemotherapy
  3. Radiotherapy
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69
Q

WHAT ARE THE RISK FACTORS FOR STOMACH CANCER?

A

H.pylori

Age

Sex

Ethnic origin - Black African or Caribbean

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70
Q

What is the most common cancer type for stomach cancer?

A

Adenocarcinomas

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71
Q

What are the clinical features of stomach cancer?

A

Dyspepsia

Later features include:
Anorexia and weight loss
Palpable mass

Troisier’s sign - palpable left supraclavicular lymph node; this is called Virchow’s node.

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72
Q

What are the investigations for stomach cancer?

A

Endoscopy and biopsy

Chest X-ray, liver enzymes and liver ultrasound

Anaemia

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73
Q

What is the staging of stomach cancer?

A

TNM

T = primary tumour

N = lymph nodes

M = metastisis

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74
Q

What are the differentials for stomach cancer?

A

carcinoma of the caecum

carcinoma of the pancreas

pernicious anaemia

uraemia

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75
Q

What is the treatment for stomach cancer?

A

Surgery ONLY

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76
Q

WHAT IS THE MOST COMMON CANCER OF THE SMALL INTESTINE?

A

Adenocarcinoma

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77
Q

What are the clinical features of small intestine cancer?

A

Occult bleeding

Obstruction

Epigastric pain

Vomiting

Jaundice

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78
Q

What are the investigations for small intestine caner?

A

Endoscopy + biopsy

Barium studies

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79
Q

What is the treatment for small intestine cancer?

A

Surgical resection

80
Q

WHAT ARE THE RISK FACTORS FOR COLORECTAL CANCER?

A

Age

Male

Environmental factors - red meat and processed meat

Obesity

81
Q

What is the most common type of cancer for colorectal cancer?

A

Adenocarcinoma

82
Q

When would you offer screening for colorectal cancer?

A

age > 40

family history of colorectal cancer

personal history of colorectal cancer

familial adenomatous polyposis coli

ulcerative colitis

83
Q

What are the symptoms of colorectal cancer?

A

Pain common to both types

Right colonic carcinoma
Weakness and anaemia

Left colonic carcinoma
Change in bowel habit

Rectal carcinoma
Rectal bleeding
Change in bowel habit
Tenesmus

84
Q

What are the investigations for colorectal cancer?

A

Colonoscopy

Barium enema, flexible sigmoidoscopy

85
Q

What is the treatment for colorectal cancer?

A

Surgical resection

+ chemotherapy

86
Q

What is Duke classificaiton?

A

Staging colorectal carcinoma

87
Q

What are the Dukes classifications?

A

COLORECTAL CANCER

  1. Duke A in gut.
  2. Duke B just outside gut.
  3. Duke C lymph node.
  4. Duke D high tie lymph node.
88
Q

WHAT IS A PEPTIC ULCER?

https://www.youtube.com/watch?v=26Rdx2EiBaA

A

Having one or more sores in the stomach, gastric ulcers or duodenum, duodenal ulcers

89
Q

What increases the risk of a peptic ulcer?

A

Stress

Use of NSAIDs

Smoking

Helicobacter pylori

90
Q

What are the symptoms of peptic ulcers?

A

Epigastric pain - aching in abdomen

Bloating

Belching

Vomiting

91
Q

When do symptoms improve for gastric and duodenal ulcers?

A

Gastric when not eating

Duodenal when eating

92
Q

What is the diagnosis of peptic ulcers?

A

Endoscopy + biopsy

C13 Urea breath test
H pylori

Biopsy
Check for malignancy
H.pylori

Gastrin Levels
If Zollinger-Ellinson syndrome - gastric tumour

93
Q

How could you treat peptic ulcers?

A

H.pylori
Antibiotics (Omeprazole, Metronidazole, Clarithromycin)

Acid lower medications

  1. Proton pump inhibitors - Lansoprazole
  2. H2 blocker - Rantidine

Surgery

94
Q

What makes gastric ulcers worse?

A

NSAIDs

Smoking

Caffiene

Alcohol

95
Q

WHAT IS GASTRITIS?

A

Irritation of stomach lining without an ulcer

96
Q

What are the causes of gastritis?

A

Excessive alcohol

NSAIDs

Spicy foods

Stress

97
Q

What are the symptoms of gastritis?

A

Epigastric pain

Loose stools

Vomiting

Haematemesis.

98
Q

How can you diagnose gastritis

A

Endoscopy + biopsy

99
Q

What is the differential diagnosis of gastritis?

A

Ulcerative collits

Chron’s

IBS

100
Q

What is the treatment for gastritis?

A

Ranitidine or PPI; eradicate H. pylori as needed.

Troxipide PO improves gastric mucus.

Endoscopic cautery may be needed.

101
Q

What is the treatment for H.pylori?

A

Lansoprazole, amoxicillin, and clarithromycin (LAC)

102
Q

WHAT IS THE STRUCTURE OF THE SMALL INTESTINE?

A

Villi and crypts.

Crypts provide new cells for the villi.

103
Q

What are the different types of malabsorption?

A

Insufficient intake.

Defective intraluminal digestion.

Insufficient absorptive area.

Lack of digestive enzyme.

Defective epithelial transport.

Lymphatic obstruction.

104
Q

What is Giardia lamblia?

A

Giardia lamblia, also known as Giardia intestinalis, is a flagellated parasite that colonizes and reproduces in the small intestine, causing giardiasis.

The parasite attaches to the epithelium by a ventral adhesive disc, and reproduces via binary fission.

105
Q

WHAT IS CROHN’S DISEASE?

A

Massive inflammation and associated ulcers.

Transmural granulomatous inflammation

106
Q

What is the cause of crohn’s?

A

Immune response occurs in reponse to pathogen but is wide and damages cell in GI tract

Defect in epithelial wall which lets bacteria in

107
Q

What are the bacteria thought to be responsible for Crohn’s?

A

Mycobacterium paratuberculosis

Pseudomonas

Listeria

108
Q

Where in the GI tract is Crohn’s disease most common?

A

Terminal Ilieum.

109
Q

Where can ulceration/granulomatous inflammation be found in Crohn’s?

A

Whole length of the GI tract

PATCHY

Throughout the mucosa, submucosa, muscular propriety and fat of the gut.

110
Q

Where do crohn’s ulcers extend?

A

All the way through muscle layer

Ulcerative colitis does not

111
Q

What are the symptoms of crohn’s?

A

Pain in assocaited areas

RLQ

Diarrhoea and blood in stool
If affecting large bowel

Malabsorption
If affect small bowel

112
Q

What are the test for crohn’s disease?

A

Acutely can sound like Appendicitis.

**_Barium Swallow_** 
COBBLESTONE APPEARANCE (may also have stricture formation and bowel shortening)

CT
Shows areas of wall thickening

Colonoscopy (and biopsy)
DIAGNOSITIC

113
Q

What does the histology look like for crohn’s?

A

Skip Lesions

Transmural inflammation

Increase in Goblet cells

Non-Caseating Granulomas

114
Q

What are the treatment option for crohn’s?

A

Maintenance:

  1. Azathioprine
  2. Mercaptopurine / Methotrexate
  3. TNF-alpa inhibitors (all the –imabs)
  4. Surgery eg. Strictures, resection

Flares:

  1. 7 days prednisolone then taper dose for 7 weeks
  2. If systemically unwell – admit for IV hydrocortisone and monitoring (incl Xrays). Supportive – fluids, transfusion if <80Hb).
  3. Switch to oral pred once improving or biologics if not improving
115
Q

What are some Crohn’s disease complications?

A

Malabsorption
-disease extent -surgical resections

Obstruction
-acute swelling -chronic fibrosis

Perforation
-acute abdomen

Fistula formation

Osteoporosis

Neoplasia
-colorectal cancer

116
Q

What different surgical resections are there?

A

Ileocolonic anastomosis

Jejunocolonic anastomosis

End-jejunostomy

117
Q

WHAT IS ULCERATIVE COLITIS?

A

Inflammation in the large intestine forming ulcers including colon and rectum

118
Q

What is the cause of ulcerative collitis?

A

Autoimmune

Stress and diet make it worse

119
Q

What trait do a large amount of people with ulcerative collitis have?

A

p-ANCAs
Thought to be due to bacteria mimicary

Increase in Sulfide gut bacteria

120
Q

What is the epidemology of ulcerative collits?

A

Family history positive

Women

30s

Caucasions and eastern europeans

121
Q

Where does ulcerative collitis start and what does it look like inside the lumen?

A

Rectum

Makes way round with no breaks

Circumfrential and continuous

122
Q

What can ulcerative colitis involve?

A

Inflammatory disorder of the colonic mucosa.

Does not involve the muscle

Forming ulcers

123
Q

How do you distinguish ulcerative colitis from Crohn’s disease?

A

Ulcerative colitis only involves mucosa whilst Crohn’s involves many layers of the gut.

124
Q

What are the symptoms of ulcerative colitis?

A
  1. Pain in LLQ
  2. Episodic or chronic diarrhoea
  3. Cramps abdominal discomfort
  4. Bowel frequency relates to severity
  5. Urgency/tenesmus.
  6. Fever, malaise, anorexia, weight.
125
Q

What are some complications of ulcerative colitis?

A

Skin
Erythema nodosum
Pyoderma gangrenosum

Colon
Blood loss toxic dilatation
Colorectal cancer.

Joints
Ankylosing Spondylitis

Eye
Iritis
Uveitis

126
Q

What would show on histology for UC?

A

Continuous superficial inflammation

Crypt Abscesses

Goblet cell depletion

Ulcers

Only rectum affected (not proximal to ileocaecalvalve)

127
Q

What investigations can be done for ulcerative colitis?

A

Bloods

BARIUM SWALLOW
Loss of haustrations and drain pipe colon

XR
No faecal shadows; mucosal thickening/islands, colonic dilatation

Stools
Exclude bacteria

Colonoscopy
Look for inflammatory infiltrate; goblet cell depletion; glandular distortion; mucosal ulcers; crypt abscesses.

Sigmoidoscopy and biopsy - ***DIAGNOSTIC

128
Q

What are the principles of management for ulcerative colitis?

A

Maintenance:

  1. Mesalazine (which is an aminosalicylate or 5-ASA)
  2. Azathioprine
  3. Mercaptopurine / Methotrexate
  4. TNF-alpa inhibitors (all the –imabs)
  5. Surgery eg. Strictures, resection, stoma

Flares:

  1. Mesalazine
  2. 7 days prednisolone then taper dose for 7 weeks
  3. If unwell – admit for IV steroids and monitoring (incl Xrays). Supportive – fluids, transfusion if <80Hb).
129
Q

What happens in barrett’s oesophagus?

A

Change from squamous epithelium to glandular. Columnar lined lower oesophagus.

130
Q

WHAT IS IBS?

A

Recurrent abdominal pain and abnormal bowel motility

131
Q

What are the symptoms of IBS?

A

Constripation and/or diarrhoea

Symptoms improve after voiding

Does not involve inflammation

132
Q

What is the cause of IBS?

A

Unknown

133
Q

What happens with visceral hypersensitivity in IBS?

A

Sensory nerve endings

Abnormaly stong response to stimuli

When eating

Recurrent abdo pain

134
Q

How does increased bowel motitlity work with IBS?

A

Short-chain carbohydrates

Fructose and lactose act as solutes

Draw water into lumen

Stretch lumen causing pain

Smooth muscle spasm and diarrhoea

Gut flora metabolise short chain and produce gas

135
Q

What is the epidemology of IBS?

A

North america
Middle aged women

Other parts
Both sexes equally

136
Q

What are some risk factors for IBS?

A

Gastroenteritis
Norovirus
Rotovirus

Stress

137
Q

What is the treatment of IBS?

A

Diet modification
Avoid certain food, apples, beans and caulifflour

Constipation
Soluble fibre
Stool softeners
Laxatives

Spasms
Antimuscarinic

Manage stress

LOW FODMAP
Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols

138
Q

WHAT IS COELIACS DISEASE?

https://www.youtube.com/watch?v=nXzBApAx5lY

A

Autoimmune response which attacks the small intestine

139
Q

What is the main culprit of coeliacs?

A

Gliadin found in gluten

140
Q

What screening tests can be used to detect coeliacs disease?

A

Anti-tTG and anti-endomyseal useful in severe cases

141
Q

What are the signs seen in the intestinal wall for coeliac’s?

A

Villus atrophy

Crypt hyperplasia

Lymphocyte infiltration

142
Q

How does coeliac’s disease present?

A

Classical
Diarrhoea
Steatorrhoea
Weight loss
Failure to thrive

Non-classical
Irritable bowel type symptoms
Iron Deficiency
Anaemia
Osteoporosis
Chronic Fatigue
Dermatitis Herpitiformis
Ataxia
Peripheral neuropathy
Hyposplenism
Ammenorhoea Infertility

143
Q

What is Dermatitis Herpetiformis?

A
  1. Rash common with coeliac disease patients.
  2. Bumpy skin rash which pops up from IgA antibodies
  3. Transglutaminase in dermal papillae
  4. Neutrophils come by and start reaction
144
Q

How do you test for coeliac’s disease?

A

Serology
Tissue transglutaminase (tTG)
Anti-endomysial antibody (EMA)
Immunoglobulins.

Endoscopy + Duodenal biopsies.

Histology
Villous atrophy.

145
Q

How do you manage coeliac’s disease?

A
  1. Gluten free diet – strict and lifelong
  2. Patients with coeliac disease often have a degree of functional hyposplenism
    - - Pneumococcal vaccine
  3. DEXA scan- osteoporotic risk
  4. Prescription entitlement Inform 10% risk in 1st degree relatives.
146
Q

What happens if coeliac’s disease is left untreated?

A

Persistent symptoms

Osteoporosis

Subfertility

Cancer risk

Quality of life.

147
Q

WHAT IS TROPICAL SPRUE?

https://www.youtube.com/watch?v=In1uajyiSxE

A

GI disease that results in malabsorption of nutrients in water

148
Q

What is the cause of tropical sprue?

A

Unknown

Maybe E. coli

149
Q

What happens to the villi in tropical sprue?

A

Villi become flattened

150
Q

What is thought to be the pathology of tropical sprue?

A

Bacteria, virus or protazoa initially damage gut wall

Cause inflammation

Enteroglucagon released by enterocytes

Decreases intentinal motility

151
Q

What are the bacteria in tropical sprue?

A

Klebsiella

E.Coli

Enterobacter

152
Q

What are the symptoms of tropical sprue?

A

Has flare ups

Diarrhoea

Abdominal pain

Fatigue

Weight loss

Dehydration

153
Q

What is the diagnosis of tropical sprue?

A

Lived in tropics and have long standing GI symptoms

Fat malabsorption
72 hour stools test on prescribed diet

Carbohydrate malabsorption
D-xylose absorption test

Imaging techniques
Endoscopy
Villi atropy

Barium swallow
intestinal wall thickening

Tissue biopsy of jejenum

154
Q

What is the treatment for tropical sprue?

A

Antibiotics
Tetracycline 250mg QDS

Nutrition
Folate
B12

155
Q

What is a complication of tropcial sprue?

A

Megaloblastic anaemia

Large immature RBCs

156
Q

WHAT IS MALLORY-WEISS TEAR?

https://www.youtube.com/watch?v=YEaP_P5HrLQ

A

A longtitudinal tear in the mucosa lining at the gastroesophageal opening

157
Q

What is the cause of mallory-weiss?

A

Anyhting that causes a suddden rise in intragastric pressure

Normaly prolonged vomiting
Persistant retching
Intentse coughing
Alcholic binge drinking
Beluimic
Gastritis

158
Q

What are the symptoms of Mallory-Weiss?

A

Upper GI pain

Severe vomiting

Vomiting blood (Hematemisis)

Bloody or black stools (Melena)

159
Q

How can you diagnose Mallory-weiss?

A

Pateint history and presenting complaint
Binge drinking?
Bulimic?

Upper GI endoscopy
See tear in mucosa

FBC
Low RBC

160
Q

What are the treatment options for Mallory-weiss?

A

Most of the time it heals itself

  1. IV fluid
  2. Oesophagus balloon tamponade
  3. Oesophageal clips
  4. Proton pump inhibitors
  5. Sclerotherapy (medications close off vessel)
  6. Coagulation therapy
161
Q

WHAT ARE OESOPHAGO-GASTRIC VARICES?

https://www.youtube.com/watch?v=06nBQxYro8s&t=37s

A

The dilated veins that are in the distal oesophagus

162
Q

What causes varices?

A

Increase in portal venous system

163
Q

What diseases cause varices?

A

Liver cirhosis

Alcoholics

164
Q

How does liver cirrhosis cause varices?

A

progressive liver fibrosis + regenerative nodules produce contractile elements in the liver’s vascular bed

Portal hypertension

Causes veins in oesophagus to become engorged and serpentine

165
Q

What are the symptoms of varices?

A

History
Alcoholic

Upper GI bleeding
More than Mallory Weiss

166
Q

How do you diagnose varices?

A

Endoscopy

FBC

PT

PTT

LFT

167
Q

What is the treatment for varices?

A

Endoscopic banding
Put rubber band around enlarged veins

TIPS
Transjugular, intrahepatic portosystemic shunting
Bypass between portal and hepatic venous circulations

Octreotide IV
Decreases blood flow
Inhibits vasodilation

Non-selective beta blockade
Propanalol

168
Q

WHAT IS ACHALASIA?

https://www.youtube.com/watch?v=Ck5Xhre-UZU&t=1s

A

Lower esopahgeal sphincter does not relax

Esophagus dilates

169
Q

What is the cause of achalasia?

A
  1. Contraction of lower oesophagael by loss of spinchter nerve innervation
  2. BY loss of ganglion cells (Auerbach’s plexus)
170
Q

What is the pathophysiology of achalasia?

A
  1. Impaired of peristalsis
  2. Lack of relaxation of LOS
  3. Increased pressure
171
Q

What are the symptoms of achalasia?

A
  1. Dysphagia of BOTH liquids and solids
  2. Patinet will regurgitate food at night
  3. Cough
  4. Pulmonary aspiration
  5. Weight loss
172
Q

What is the diagnosis of achalasia?

A

Oesophageal monometry - catheter down esophagus
Assess peristalsis
100% failed peristalsis

Function of LOS
Incomplete relaxation
Increased pressure

Barium swallow
Fluid stuck in esophagus
Bird’s beak

173
Q

What is the treatment for achalasia?

A

Try to open LOS

Decrease pressure at LOS

Surgical myotomy
Cut muscles of LOS

Balloon dilation
Then proton pump inhibitors

174
Q

WHAT IS SCLERODERMA?

A

Collagen deposition in skin and other organs

175
Q

What is the epidemology of scleroderma?

A

30-50 years

Women more than men

176
Q

What is the cause of scleroderma?

A

Unknown agent causes disease in suseptable host

177
Q

What antibody is involved with scleroderma?

A

Limited: Anticentromere

Diffuse: Antitopoisomerase-1

178
Q

What are the symptoms of scleroderma?

A

CREST

Calcinosis
Raynaud’s phenomenom
Esophageal dysfunction - acid reflux and decrease in motility
Sclerodactyly - thickening and tightening of the skin on the fingers and hands
Telangiectasis - dilation of capillaries causing red marks on surface of skin

Skin develops hard texture
Cannot be wrinkled

Face is expressionless

Claw like fingers

179
Q

What is the diagnosis of sclermoderma?

A

Radiography
Diffuse widening of peridontal ligament space

Microscopy
Excess collagen in stroma of organ involved

180
Q

What is the cure of scleroderma?

A

No cure

Immunosuppresants
Cyclophosphamide

181
Q

WHAT IS GASTROINTESTINAL REFLUX?

A

Symptoms or mucosal damage produced by abnormal reflux of gastric content into the oesophagus

182
Q

What are some causes of GI reflux?

A

Obesity

Eating large meals

Tight clothing

Pregnancy

Drugs
Tricylic depressants
Anticholinergics

183
Q

What are the symptoms of GI reflux?

A

Heartburn

Acid regurgitation

184
Q

What is the mechanism in GI reflux?

A

In the normal individual the pressure in the intra-abdominal pressure exceeds the intra-thoracic pressure. This differential is exacerbated in the obese person. Obesity has two effects:

185
Q

What are the investigations for GI reflux?

A

Endoscopy

Barium radiology

24 hour oesophageal pH monitoring

186
Q

What is the management for GI reflux?

A

PPI
Omeprazole

H2RA
Ranitidine

187
Q

WHAT IS ISCHAEMIC COLITIS?

A

Ischaemic colitis is typically, a chronic segmental process in elderly patients affecting the watershed areas of the splenic flexure or rectosigmoid area. It is caused by transient critical ischaemia.

188
Q

What is the cause of ischaemic colitis?

A

The most common cause is arterial occlusion, usually of the superior mesenteric artery.

189
Q

What are the clinical features of ischaemic colitis?

A

Cramp-like, left sided abdominal pain which lasts for a few hours, and is followed by rectal bleeding.

The bleeding is dark red, often without faeces, and may occur 2-3 times over a period of 12 hours.

190
Q

What are the investigations for ischaemic colitis?

A

Plain abdominal x-ray - may reveal mucosal oedema at the splenic flexure, so called “thumb printing”; a single segment is affected with symmetrical stricture

191
Q

What is the treatment for ischaemic colitis?

A

May resolve

Strictures may develop which require surgical resection

192
Q

WHAT IS A PILONIDAL SINUS?

A

‘Pilonidal’ means a nest of hairs.

A pilonidal sinus is a sinus that contains a tuft of hairs.

These sinuses are commonly found in the skin covering the sacrum and coccyx but can occur between the fingers, particularly in barbers, and at the umbilicus.

193
Q

What are the clinical features of a pilonidal sinus?

A

Recurrent episodes of pain or sepsis.

There are often periods of several months between episodes.

As the size of the sinus increases the frequency of painful episodes also increases

194
Q

What is the management of a pilinidal abscess?

A

If a pilonidal sinus is small, then it may only require antibiotic treatment. If the sinus develops into an acutely inflamed abscess, then it will require drainage.

There are three alternative procedures that may be undertaken:

the lesion can be incised and laid open

the lesion can be completely excised

the lesion can be curetted and injected with phenol

195
Q
A

ΩΩ 2a Bateman - Systems Based (11 decks)

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