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Phase 2a Medicine > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

What is the most common intraluminal obstruction?

A

Colorectal cancer

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2
Q

What can cause intraluminal obstruction?

A
  1. Tumour
  2. Diaphragm disease
  3. Meconium ileum
  4. Gallstone ileus
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3
Q

What can cause intramural obstruction?

A
  1. Crohn’s
  2. Diverticulitis
  3. Tumours
  4. Hirschsprung’s disease
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4
Q

How can Crohn’s cause intramural obstruction?

A
  1. Fibrosis
  2. Inflammation
  3. Granulomas
  4. Cobble stone mucosa
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5
Q

How do diverticula form?

A

Weaknesses in bowel wall where vessels come in

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6
Q

What can occur if diverticula fill with faeces?

A

Faecal peritonitis

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7
Q

What causes extraluminal obstruction?

A
  1. Adhesions
  2. Volvulus
  3. Tumour
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8
Q

How does volvulus occur?

A

Sigmoid colon twists on itself

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9
Q

What is the most common tumour to cause extraluminal obstruction/

A

Ovarian cancer

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10
Q

What is an intestinal obstruction?

A

Blockage to lumen of gut

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11
Q

What is a volvus?

A

A rotation of a segment of bowel

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12
Q

What is intesussuption?

A

Telescoping one hollow structure into its distal hollow structure

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13
Q

What is atresia?

A

Absence of opening or failure of development of hollow structure

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14
Q

How can obstruction conditions be classified?

A
  1. Site
  2. Extent of luminal obstruction
  3. Mechanism
  4. Pathology
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15
Q

What are the symptoms of bowel obstruction?

A
  1. Anorexia
  2. Nausea
  3. Distension
  4. Abdominal pain
  5. Constipation
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16
Q

What is the most common type of intestinal obstruction?

A

Small bowel obstruction (SBO)

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17
Q

Give 4 causes of SBO

A
  1. Adhesions (surgery)
  2. Hernia
  3. Crohns
  4. Appendicitis
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18
Q

What is the acute presentation of large bowel obstruction (LBO)?

A
  1. Abdominal distention
  2. Abdominal discomfort
  3. Pain
  4. Vomiting
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19
Q

Give 4 causes of LBO

A
  1. Malignancy
  2. Volvulus
  3. Imperforate anus
  4. Hirschsprung disease
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20
Q

What increases incidence of adhesive obstruction?

A
  1. Pelvic surgery
  2. Gynaecology surgery
  3. Colorectal surgery
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21
Q

What is a hernia?

A

Abnormal protrusion of viscus through normal or abnormal defects of body cavity

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22
Q

What is a complication of untreated hernia?

A

Strangulation

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23
Q

What is the presentation of hernia?

A
  1. Lumps

2. Pain

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24
Q

Where do volvulus occur?

A

Part of the bowel with mesentery

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25
Q

What causes volvulus?

A
  1. Caecal rotation
  2. Congenital band
  3. Adhesional band
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26
Q

What is the mechanism of intesussuption?

A

Imbalance in longitudinal forces along intestinal wall

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27
Q

What are the symptoms of intesussuption?

A
  1. Colicky pain
  2. Vomiting
  3. Constipation
  4. Abdominal distention
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28
Q

What is the pathophysiology of familial adenomatous polyposis?

A
  1. Mutation in gene causes misfiled protein
  2. Protein won’t bind to beta catenin so levels go up
  3. Binds to DNA to up regulate genes that cause epithelial proliferation
  4. Adenoma etc. form
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29
Q

What is the Rx for familial adenomatous polyposis?

A

Remove colon to prevent cancer

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30
Q

What is missing in hereditary nonpolyposis colorectal cancer (HNPCC)?

A

Gene that encodes DNA repair proteins

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31
Q

What are the implications for therapy in HNPCC?

A
  1. Tolerance of 5-FU
  2. Don’t recognise DNA damage
  3. Apoptosis not activated
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32
Q

Where is most colorectal cancer?

A

Lower end (38%); rectum (28%)

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33
Q

How can lower end colorectal cancer be identified?

A

Digital rectal exam

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34
Q

Where is the first place GI tumours metastasise to?

A

Liver

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35
Q

What is resected during endoscopy to prevent colorectal adenocarcinoma?

A

Adenoma

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36
Q

What is the pathophysiology for gastric ulcers?

A
  1. Mucosal ischaemia means cells are unable to produce mucin
  2. Cells are not protected from stomach acid
  3. Stomach acid kills cells and get micro-ulcer
  4. Acid enters hold and damages more cells to get bigger ulcer
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37
Q

What are the signs of gastric ulcers?

A
  1. Tachycardia
  2. Low BP
  3. High RR
  4. Bleeding (see on scans)
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38
Q

What is the Rx for gastric ulcers?

A
  1. Fluids/blood
  2. Reversal mucosal ischaemia
  3. H2 blocker/PPI inhibitor - reduce acid
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39
Q

What are the risks for increased stomach acid?

A
  1. Stress
  2. Helicobacter
  3. Aspirin
  4. Bile reflux
  5. Alcohol
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40
Q

How does helicobacter cause ulceration?

A

Produce chemicals which attract inflammatory cells which enter gastric epithelium to damage cells and cause ulceration

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41
Q

Why does helicobacter increase risk of gastric cancer?

A

Changes gastric epithelium into intestinal metaplasia

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42
Q

What are the results of ulceration?

A
  1. Bleeding
  2. Haemorrhage (vomit blood)
  3. Peritonitis
  4. Pancreatitis
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43
Q

How does malabsorption manifest?

A
  1. Weight loss with normal calories
  2. Pale floating faeces
  3. Anaemia
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44
Q

What are the causes of malabsorption?

A
  1. Insufficient intake
  2. Defective intraluminal digestion
  3. Insufficient absorptive areas
  4. Lack of digestive enzymes
  5. Defective epithelial transport
  6. Lymphatic obstruction
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45
Q

What causes defective intraluminal digestion?

A
  1. Pancreatic insufficiency
  2. Defective bile secretion
  3. Bacterial overgrowth
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46
Q

Give an example of gluten sensitive enteropathy

A

Coeliac disease

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47
Q

What causes gluten sensitive enteropathy?

A

Villous atrophy and hyper plastic crypts

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48
Q

Describe gluten sensitive enteropathy gut wall

A

Flat epithelium and marked increase in epithelial lymphocytes

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49
Q

What is the pathophysiology of coeliac disease?

A
  1. Gliadin peptide from gluten is absorbed and presented to antigen presenting cell
  2. Produces toxic T cells –> lymphocytes
  3. Lymphocytes release inflammatory mediators when exposed to gluten
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50
Q

What happens if Crohn’s disease is uncontrolled?

A

Get cobblestone mucosa which reduces SA

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51
Q

What are the complications of small intestinal resection?

A
  1. Malabsorption

2. Fatty liver

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52
Q

When might a small intestinal resection or bypass be done?

A
  1. Morbid obesity
  2. Crohn’s disease
  3. Infarcted small bowel
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53
Q

What can cause lack of digestive enzymes?

A
  1. Disaccharidase deficiency

2. Bacterial overgrowth

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54
Q

What can cause lymphatic obstruction?

A
  1. Lymphoma

2. Tuberculosis

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55
Q

What can cause intestinal inflammation?

A
  1. Diverticulitis
  2. Ischaemic colitis
  3. Infective colitis
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56
Q

What can cause chronic idiopathic inflammatory bowel disease (CIIBD)?

A
  1. Crohn’s disease

2. Ulcerative colitis

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57
Q

What is the histology of Crohn’s?

A
  1. Patchy inflammation from mouth to anus
  2. Transmural
  3. White ulcers with patchy distribution
  4. Fibrosis and cobblestone mucosa
  5. Granulomas
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58
Q

What are 6 complications of Crohn’s?

A
  1. Malabsorption
  2. Chronic fibrosis
  3. Perforation
  4. Fistula formation
  5. Anal fissure
  6. Colorectal cancer
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59
Q

What are the signs of colon fistula?

A

Watery diarrhoea and malabsorption

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60
Q

What can confirm Crohn’s diagnosis?

A

Skin tags full of granulomas

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61
Q

What is the pathology of ulcerative colitis?

A
  1. Inflammation is all mucosal
  2. Starts in rectum and is continuous
  3. Stops before ilium
  4. Red inflamed mucosa
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62
Q

What are 5 complications of ulcerative colitis?

A
  1. Fatty change to liver
  2. Blood loss from colon
  3. Arthritis
  4. Iritis
  5. Erythema nodosum
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63
Q

What gene is associated with colitis?

A

HLA B27

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64
Q

What is coeliac disease?

A

Chronic autoimmune enteropathy triggered by ingested gluten in genetically susceptible individuals

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65
Q

What is the prevalence of coeliac disease in the UK?

A

1%

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66
Q

What is the commonest age for presentation of coeliac disease?

A

4th to 6th decade

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67
Q

What environmental factors can cause coeliac disease?

A
  1. Viral infections
  2. Dysbiosis
  3. Gluten
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68
Q

What individual factors cause coeliac disease?

A
  1. Genetic predisposition
  2. Association with HLA DQ2 (95%) or DQ8
  3. Tissue transglutanimase
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69
Q

What is gluten made off?

A

Glutenins and gliadins

70
Q

What do the mutations in HLA DQ2/8 cause?

A

Affect ability to bind gluten peptides properly

71
Q

What are the classical symptoms of coeliac disease?

A
  1. Diarrhoea
  2. Steatorrhoea
  3. Weight loss
  4. Failure to thrive
72
Q

Give 4 non-classical symptoms of coeliac disease

A
  1. Irritable bowel symptoms
  2. Osteoporosis
  3. Anaemia
  4. Chronic fatigue
73
Q

Give 3 diseases associated with coeliac disease

A
  1. T1DM
  2. Autoimmune thyroid disorders
  3. Dermatitis herpetiformis
74
Q

What is dermatitis herpetiformis?

A

Chronic autoimmune blistering skin condition

75
Q

What proportion of dermatitis herpetiformis pt. have coeliac disease?

A

70%

76
Q

What is the Dx for coeliac disease?

A
  1. IgA tissue transglutanimase
  2. IgA anti-endomysial antibody
  3. Upper GI endoscopy
  4. Histology
77
Q

When is testing for coeliac disease done?

A

When on a gluten-containing diet for 6 weeks

78
Q

What is it called when squamous epithelium changes to glandular mucosa in the oesophagus?

A

Columnar lined lower oesophagus (CELLO) or Barrett’s oesophagus

79
Q

What is metaplasia?

A

Change in differentiation of a cell from one fully-differentiated type to a different fully-differentiated type

80
Q

What can cause metaplasia in the oesophagus?

A

Repeated acid reflux

81
Q

What are the risk factors for oesophageal squamous cell carcinoma?

A
  1. Heavy smoking

2. Alcohol

82
Q

What are the risk factors for oesophageal adenocarcinoma?

A
  1. Obesity

2. Acid reflux

83
Q

What is the most common age for oesophageal cancer?

A

80s and 90s

84
Q

What is the prognosis for oesophageal cancer?

A

<10% in most prevalent age

85
Q

What are risk factors for gastric cancer?

A
  1. Smoked food
  2. Pickled food
  3. Helicobacter pylori
  4. Pernicious anaemia
86
Q

What is the most prevalent age for gastric cancer?

A

70s

87
Q

What is the 5 year survival if gastric cancer is caught early?

A

90%

88
Q

What is the 5 year survival if gastric cancer invades the muscular wall?

A

60% if completely resected

89
Q

What is the 5 year survival for gastric cancer if it can’t be resected?

A

10-15%

90
Q

What are the diagnostic criteria for anorexia nervosa?

A
  1. Restriction of energy intake leading to a significantly low body weight
  2. Intense fear of gaining weight, even though underweight
  3. Disturbance in experience of body shape
91
Q

What are the subtypes of anorexia nervosa?

A
  1. Restricting

2. Binge eating/purging

92
Q

What are the diagnostic criteria of bulimia nervosa?

A
  1. Recurrent episodes of binge eating
  2. Recurrent inappropriate compensatory behaviour to prevent weight gain
  3. Bing eating and compensating at least once a week for 3 months
  4. Self-evaluation influenced by body shape
93
Q

How are binge eating episodes characterised?

A
  1. Eating in a discrete amount of time large amounts of food

2. Sense of lack of control over eating during an episode

94
Q

What are binge eating episodes associated with?

A
  1. Eating much more rapidly than normal
  2. Eating until feeling uncomfortably full
  3. Eating large amounts of food when not feeling physically hungry
  4. Eating alone because of feeling embarrassed by how much one is eating
  5. Feeling disgust, depressed or guilty following a binge
95
Q

How does binge eating disorder differentiate from bulimia?

A

No compensatory or purging behaviours

96
Q

What is the most common age for eating disorders?

A

14-40

97
Q

What is the prevalence of eating disorders amongst females?

A

7%

98
Q

What are the risk factors for eating disorders?

A
  1. Genes
  2. Temperament
  3. Family interaction
  4. Social pressures
  5. Trauma
99
Q

What factors lead to a need for control?

A

Low self-esteem and perfectionism

100
Q

What are some triggers for eating disorders?

A
  1. Teasing about appearance
  2. Positive comments about weight loss
  3. Illness
  4. New social circle
101
Q

What are the maintaining factors for eating disorders?

A
  1. Positive reinforcement initially

2. Later, terror at losing control

102
Q

What must be tested for in eating disorders?

A
  1. Severe restriction of food/fluid
  2. Electrolyte imbalance - K
  3. Bone deterioration - bone scan
  4. Physical damage e.g. blood in vomit
  5. Alcohol/drug intake
103
Q

What are the urgent signs to assess for in eating disorders?

A
  1. Muscular weakness
  2. Problems breathing
  3. Deterioration of consciousness
  4. Cardiac signs
  5. Rapid weight loss
  6. Risky behaviours
104
Q

What is the most effective motivator in eating disorders?

A

Early behavioural change with reinforcement for doing well

105
Q

What are the Rx for bulimia nervosa and binge eating disorder?

A
  1. CBT
  2. Guided CBT self help
  3. Group CBT
106
Q

What are the Rx for anorexia nervosa?

A
  1. Family therapy
  2. CBT
  3. Maudsley AN treatment model
  4. Specialist supportive clinical management
107
Q

What are the Crohn’s symptoms?

A
  1. Diarrhoea
  2. Fever
  3. Fatigue
  4. Abdo pain
  5. Bloody stool
108
Q

What are the Crohn’s Ix?

A
  1. Bloods e.g. CRP, FBC
  2. Colonoscopy
  3. MRI small bowel
  4. USS
  5. CT
  6. Pelvic MRI
109
Q

What is the Rx for Crohn’s?

A
  1. Prednisolone
  2. Liquid diet
  3. Azathioprine
  4. MTX
  5. Adalimumab
  6. Surgical resection
110
Q

What are the colitis symptoms?

A
  1. Diarrhoea with blood or pus
  2. Abdo pain
  3. Rectal pain
  4. Rectal bleeding
  5. Urgency to defecate
111
Q

What is the investigation for colitis?

A
  1. Routine bloods
  2. Faecal calprotectin
  3. Stool sample
  4. Colonoscopy with biopsy
  5. AXR
  6. CT abdomen
112
Q

What is the Rx for colitis?

A
  1. Mesalazine
  2. IV corticosteroids
  3. Total proctocolectomy
113
Q

What are the IBS symptoms?

A
  1. Stomach cramp
  2. Bloating
  3. Diarrhoea
  4. Constipation
114
Q

What foods trigger IBS?

A
  1. Fibre foods
  2. Alcohol
  3. Caffeine
  4. Carbonated drinks
  5. Fatty foods
115
Q

What is the Ix for IBS?

A
  1. Coeliac test
  2. Colonoscopy
  3. Sigmoidoscopy
  4. AXR
  5. Stool tests
116
Q

What is the Rx for IBS?

A
  1. Lifestyle changes
  2. Dietary change
  3. Loperamide
  4. Laxatives e.g. celevac
117
Q

What is the pathophysiology of gastroesophageal reflux disease (GORD)?

A
  1. Lower oesophageal sphincter relaxations
  2. Reflux of bile, acid, pepsin
  3. Oesophageal mucosal injury
118
Q

What are the symptoms of GORD?

A
  1. Heartburn
  2. Acid reflux
  3. Oesophagitis
  4. Bad breath
  5. Bloating
119
Q

What are the Ix for GORD?

A
  1. Oesophageal pH monitoring test
  2. Endoscopy
  3. Oesophageal pressure test
  4. Barium meal
120
Q

Wha are the Rx for GORD?

A
  1. Lifestyle changes
  2. PPIs
  3. H2-receptor antagonists
121
Q

What is the pathophysiology of appendicitis?

A

Appendix acutely inflamed as lumen becomes blocked

122
Q

What are the symptoms of appendicitis?

A
  1. Pain in central abdomen
  2. Pain moves to LRQ
  3. Pain on palpitation
  4. Nausea
  5. Anorexia
123
Q

What are the Ix for appendicitis?

A
  1. FBC
  2. Abdominal and pelvic CT
  3. Urinary pregnancy test
  4. USS
  5. Urinalysis
124
Q

What is the Rx for appendicitis?

A

Appendectomy

125
Q

What is the pathophysiology of pseudo-obstruction?

A

Severe impairment in ability of intestines to push food through

126
Q

What are the symptoms of pseudo-obstruction?

A
  1. Distension
  2. Abdo pain
  3. N&V
  4. Constipation
  5. Diarrhoea
127
Q

What is the Ix for pseudo-obstruction?

A
  1. Abdominal exam
  2. AXR
  3. Bloods
128
Q

What is the Rx for pseudo-obstruction?

A
  1. Abx
  2. Analgesia
  3. Endoscopic decompression
  4. Neostigmine
129
Q

What is diverticulitis?

A

Inflammation of diverticula

130
Q

What are the risk factors for diverticulitis?

A
  1. Low dietary fibre
  2. Obesity
  3. Smoking
  4. FHx
  5. NSAID use
131
Q

What are the symptoms of diverticulitis?

A
  1. Acute abdominal pain
  2. Altered bowel habit
  3. Anorexia
  4. Pyrexia
132
Q

What are the Ix for diverticulitis?

A
  1. Routine bloods
  2. Venous blood gas
  3. Group and Save
  4. Sigmoidoscopy
  5. CT abdomen-pelvis
133
Q

What is the Rx for diverticulitis?

A
  1. IV Abx
  2. IV fluids
  3. Bowel rest
  4. Sigmoid colectomy
134
Q

What usually causes gastritis?

A

H pylori

135
Q

What are the symptoms of gastritis?

A
  1. Indigestion
  2. Burning stomach pain
  3. Nausea
  4. Feeling full
136
Q

What is the diagnosis of gastritis?

A
  1. Stool test
  2. Breath test for H pylori
  3. Endoscopy
  4. Barium swallow
137
Q

What is the Rx for gastritis?

A
  1. Antacids
  2. H2 blockers
  3. Omeprazole
  4. Abx
138
Q

What is the pathophysiology of ischaemic colitis?

A

Inflammation and injury of large intestine result from inadequate blood supply

139
Q

What are the symptoms of ischaemic colitis?

A
  1. Abdo pain
  2. Bright red blood in stool
  3. Urgency to move bowels
  4. Diarrhoea
  5. Nausea
140
Q

What is the investigation for ischaemic colitis?

A
  1. Stool sample
  2. CT
  3. MR angiography
  4. Colonoscopy
141
Q

What is the Rx for ischaemic colitis?

A
  1. Abx
  2. IV fluids
  3. Surgical repair
  4. Colectomy
142
Q

What is mesenteric ischaemia?

A

Injury to small intestine occurs due to not enough blood supply

143
Q

What are the symptoms of mesenteric ischaemia?

A
  1. Abdo pain
  2. Urgent need for bowel movement
  3. Fever
  4. N&V
144
Q

What is the Ix for mesenteric ischaemia?

A
  1. ABG
  2. Routine bloods
  3. CT with contrast
  4. CXR
145
Q

What is the Rx for mesenteric ischaemia?

A
  1. Broad spectrum Abx
  2. Urgent surgical resuscitation
  3. Excision of necrotic bowel
  4. Revascularisation of bowel
146
Q

What is a Mallory-Weiss tear?

A

Tear of tissue of lower oesophagus

147
Q

What are the common causes of Mallory-Weiss tear?

A

Violent coughing or vomiting

148
Q

What are the complications of Mallory-Weiss tear?

A
  1. Anaemia
  2. Fatigue
  3. SOB
  4. Shock
149
Q

What are the symptoms of Mallory-Weiss tear?

A
  1. Bright red/coffee grain vomit
  2. Black tar-like stools
  3. Bloody stools
  4. Weakness
  5. SOB
150
Q

What is the Ix for Mallory-Weiss tear?

A
  1. Endoscopy
  2. Routine bloods
  3. ECG
151
Q

What is the Rx for Mallory-Weiss tear?

A
  1. Resuscitation

2. Endoscope to relieve bleeds

152
Q

What is the pathology of haemorrhoids?

A
  1. Abnormal venous dilatation to anal cushions
  2. Vascular thrombosis
  3. Degeneration in collagen fibres
153
Q

What are the symptoms of haemorrhoids?

A
  1. Pain when sitting
  2. Pain during bowel movement
  3. Itching around anal region
  4. Bright red blood on stools
154
Q

What is the Ix for haemorrhoids?

A
  1. DRE

2. Sigmoidoscopy

155
Q

What is the Rx for haemorrhoids?

A
  1. High fibre diet
  2. Topical cream with hydrocortisone
  3. Soak in warm bath
  4. Analgesia
156
Q

What is an anal fistula?

A

Small tunnel that develops between end of bowel and skin near anus

157
Q

What are the symptoms of anal fistula?

A
  1. Frequent anal abscesses
  2. Pain around anus
  3. Pus from opening
  4. Pain with bowel movement
158
Q

What are the Ix for anal fistula?

A
  1. Proctoscopy

2. MRI

159
Q

What are the Rx for anal fistula?

A
  1. Fistulotomy

2. Seton placement

160
Q

What is an anal fissure?

A

Tear or ulcer that develops in lining of large intestine near anus

161
Q

What are the symptoms of anal fissure?

A
  1. Visible tear in skin around anus
  2. Skin tag near tear
  3. Pain during bowel movements
  4. Bloody stools
  5. Burning or itching in anal area
162
Q

What are the Ix for anal fissure?

A
  1. Rectal exam

2. Anoscopy

163
Q

What is the Rx for anal fissure?

A
  1. Stool softeners
  2. Drink more fluids
  3. Lidocaine
  4. Hydrocortisone cream
  5. CCB
164
Q

What are the symptoms for perianal abscess?

A
  1. Pain throbbing and constant
  2. Skin irritation around anus
  3. Pus discharge
  4. Constipation
  5. Pain on bowel movement
165
Q

What are the Ix for perianal abscess?

A
  1. Anal USS
  2. CT
  3. Anal exam
166
Q

What is the Rx for perianal abscess?

A
  1. Surgical drainage

2. Abx

167
Q

What is a pilonidal sinus?

A

Small hole of tunnel in skin that may fill with fluid or pus in cleft at top of buttocks

168
Q

What are the symptoms for pilonidal sinus?

A
  1. Pain
  2. Swelling
  3. Pus-filled abscess
169
Q

What are the Ix for pilonidal sinus?

A

Clinical diagnosis

170
Q

What is the Rx for pilonidal sinus?

A
  1. Abx
  2. Surgical drainage
  3. Analgesia

Phase 2a Medicine (15 decks)

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