GatroIntestinal Flashcards
1
Q
What cytokines are strongly present in Crohn’s disease
A
TNF-Alpha, IL1,IL6
2
Q
Most common place for Crohns to affect
A
Terminal Iliuem
3
Q
Risk Factor for Crohn’s
A
Family history, Jewish, Smoking
4
Q
How would you describe the inflamation in Crohn’s disease
A
Transmural (affects all 4 layers)
5
Q
Signs/symptoms of Crohns
A
Pain in RUQ, Malabsorption, B12/ folate/ iron deficiency, gall+ kidney stones, watery diarrhoea
6
Q
Why does crohns cause gallstones
A
Small intestine has affected the ability to absorb bile salts and without bile salts, cholesterol can collect in the gallbladder to form stones
7
Q
What are the extraintestinal symptoms of Crohns disease
A
Apthous mouth ulcers, uveitis episcleritis, erythema nodosum, pyoderma gangrenosum, spondylararthitis
8
Q
Is pANCA positive in Crohns or Ulcerative Colitis
A
Ulcerative colitis
9
Q
What antibodies may be present in crohns
A
ASCA (Anti- Saccharomyces cerevisiae antibodies)
10
Q
What would you see on endoscopy in crohns
A
Skip lesions, cobblestoning, string sign
11
Q
What would you see on a biopsy in crohns
A
Transmural inflammation with non-caseating granulomas
12
Q
How do you treat a flare of crohns
A
Prednisolone + sulfasalazine (given as a suppository)
13
Q
How do you treat crohns in remission
A
Azathioprine
Methotrexate
14
Q
How does infliximab help in crohns
A
Anti TNF-alpha
15
Q
What IL12 and IL23 inhibitor is used to treat crohns
A
Ustekinumab
16
Q
Is surgery curative in crohns
A
No
17
Q
What are the complications of crohns disease
A
Fistula, strictures, abscesses, small bowel obstruction
18
Q
What gene is associated with Ulcerative Colitis
A
HLA B27
19
Q
What is inflammation of the anus also known as
A
Poctitis
20
Q
Risk factors for UC
A
Family history, Jewish, Smoking is protective
21
Q
How would you describe the inflammation in UC
A
Confined to mucosa
22
Q
Intestinal symptoms of UC
A
Pain in LLQ, Tenesmus (rectal defecation pain), bloody mucusy watery diarrhoea
23
Q
What are the extraintestinal signs/ symptoms of UC
A
Uveitis/ episcleritis
Pyoderma gangrenosum/ erythema nodosum
Spondyloarthropathy
Primary sclerosing cholangitis (90% of UC patients have PSC, 75% of all IBD patients)
24
Q
What antibody present in UC
A
pANCA is positive as well as a raised fecal calprotectin
25
What would you see on colonoscopy/ XR in UC
Continuous inflammation, 'Lead Pipe' sign
26
What would you see on biopsy in UC
Mucosal inflammation with crypt hyperplasia
27
What scoring system is used to class the severity of flares in UC
TRULOVE +WITTS
28
How do you treat a flare of UC
Sulfasalazine (very good) and prednisolone (give first if severe)
29
How to you treat UC in remisiion
Azathioprine
Methotrexate
Cyclosporin
30
What class of drugs is cyclosporin
Calcineurin inhibitor
31
What monoclonal antibody is used to treat UC
Infliximab (Anti TNF-alpha)
32
What is the curative treatment for UC
Colectomy
33
What is the main complication of UC
Toxic Megacolon (the leading cause of death)
This is abnormal dilation of the large colon
34
What typer hypersensitivity reaction occurs in coeliac disease
Type 4 (to gluten)
35
What genes make people susceptible to coeliac
HLADQ2+ DQ8 (95%)
36
What endocrine disorders is coeliac disease associated with
Addison's and thyroid disorders
37
What is the pathophysiology of coeliac disease
Prolamins in gluten (alpha Gliadin) bind to IgA and then interact w ttG (anti-tissue transglutaminase)
This results in the formation of more IgA, IgA anti-ttG and endomysial (EMA) antibodies.
Leads to inflammation in the small bowel.
38
What are the symptoms due to malabsorption in coeliac disease
Fe, B-12, Folate deficiency (Anemia)
Steatorrhoea (fatty stool)
Diarrhoea
Weight loss and failure to thrive
39
Other than malabsorption, what are other signs/ symptoms of celiac disease
Dermatitis Herpetiformis:- papular rash on shins+ knees due to IgA deposition (itchy blisters and bumps)
40
What is the 1st (and 2nd)line test for coeliac disease
anti-ttG (best, most specific)
Increased Total IgA (may get false negative in IgA deficient patient
2nd:- EMA
41
What is the Gold standard/ diagnostic test for coeliac disease (and what would you see)
Duodenal biopsy:- crypt hyperplasia + villous atrophy (+ epithelial lymphocyte infiltration) (SPRUE)
42
What is the treatment for coeliac disease
Stop eating gluten + replace vitamins/ mineral deficiency
43
What should you monitor in someone with coeliac disease
Osteoporosis with DEXASCANS
44
What is tropical SPRUE
An enteropathy associated with tropical travel which produces similar SPRUE biopsy to coeliac
45
What is the treatment for tropical sprue
Antibiotics
46
How long do you have to have GI symptoms with no underlying cause for IBS
3+ (related to psychology:- stress, poor diet)
47
What are the 3 types of IBS
IBS-C:- mostly constipation
IBS:-D:- mostly diarrhoea
IBS-M:- mixed constipation and diarrhoea
48
What are the signs and symptoms of IBS
Abdo pain + bloating relieved from defication
Altered stool form/ frequency
49
How would you exclude coeliac, IBD and infections
Coeliac:- serology
IBD:- fecal calprotectin
infections:- ESR/CRP/ blood cultures
50
Treatment for IBS
Conservative:- patient education and reassurance
Moderate:- IBS-C:- laxitives
IBS-D:- antimotility drug
Severe:- TCA (tricyclic antdepressants
51
What is GORD
Gastric reflux due to a decrease in pressure across LOS- causes oesophagitis
52
What are causes for GORD
Increase in intraabdominal pressure:- prego, obesity
Hiatal Hernia
Drugs (anti-muscarinic)
Scleroderma (LOS= scarred)
53
`What are the symptoms of GORD
Heartburn (retrosternal burning chest pain)
Chronic cough+ nocturnal asthma
Dysphagia (difficulty swallowing)
Symptoms worse when laying down
54
What to do in patients with GORD symptoms but no red flags
Go straight to treatment
55
What are the red flags in GORD
Dysphagia, haematemesis (vomiting blood), weight loss
56
What should you do in red flag GORD patient
Endoscopy:- oesophagitis or Barrets oesophagus
Oesophageal manometry:- measure LOS pressure
+ monitor gastric acid pH
57
Treatment for GORD
Conservative lifestyle changes:- Smaller meals , 3+ hours before bed
Proton pump inhibitor (H2RA if CI)
Antacids
Alginates (Gaviscon)
58
What is a side effect of antacids
Diahhroea
59
What is the last resort treatment for GORD
Surgical tightening of LOS; Nissen fundoscopy
Wrap fundus around LOS externally to increase pressure across it
60
What are the complications of GORD
Oesophageal strictures and Barrets oesophagus
61
What age do you usually have oesophageal strictures in GORD
60+
62
How do you treat oesophageal strictures
Oesophageal dilation + PPI
63
What % of GORD patients develop barrets
10%
64
What cause of GORD is always involved in barrets
Hiatal hernia
65
What epithelia change is seen in Barrets osophegus
SSNK to simple columnar
66
What group of people most at risk to develop Barrets
middle-aged Caucasian male with a history of GORD + progressively worsening dysphagia
67
How do you diagnose Barrets Oesaphgues
Biopsy
68
What is a Mallory Weiss Tear
A tear in the mucosal membrane of the LOS due to a sudden increase in intra-abdominal pressure
69
What is the usual presentation of a Mallory West tear
Young male with an acute history of retching (such as after a night out) eventually causing haematemesis
70
What are the risk factors for a Mallory west tear
Alcohol, chronic cough, hyperemesis gravidarum (severe N+V in pregnancy)
NO HISTORY OF LIVER DISEASE/ PULMONARY HYPERTENSION
71
GS investigation for mallory west tear
Endoscopy
72
Treatment for Mallory west tear
Most spontaneously heal within 24hr
73
What scoring system is used for the severity of an upper GI bleed
ROCKALL score
74
Are gastric ulcers more common in the greater or lesser curvature
Lesser
75
What are 3 causes of gastric ulcer
Helicobacter pylori
NSAIDS
Zollinger Ellison syndrome (gastrin producing tumour)
76
What is zollinger ellison syndrome
A pancreatic tumour that produces excess gastrin and thus gastric acid hypersecretion
77
What are the symptoms of gastric ulcers
Epigastric pain worse on eating
Typically weight loss
78
What are red flags in patients with gastric/ duodenal ulcers
55+, haematemesis, anemia, dyssphagia
79
What investigations do you perform on a patient with suspected gastric ulcers but no red flag symtpoms
C-urea breath test (detect helicobacter pylori)
Stool antigen test (detect H. pylori)
80
What investigations do you perform on a patient with suspected gastric ulcers with red-flag symptoms
Urgent Endoscopy+ biopsy
81
What artery is at risk from rupture due to gastric ulcers
L. Gastric (not very common) (far less likely than a gastroduodenal artery rupture in patients with duodenal ulcers)
82
Are gastric or duodenal ulcers more common
Duodenal 66%;33%
83
What is the most common location for a duodenal ulcer
D1/D2
84
What is the main cause of duodenal ulcers
Helicobacter pylori infection
NSAIDS and ZE more prone to gastric
85
What are the symptoms of duodenal ulcers
Epigastric pain worse between meals and better with food
Typically weight gain
86
If there are no red flags, what investigations do you perform on a patient with duodenal ulcers
Urea breath test
Stool antigen test
87
If red flags are present, what investigations would you perform on a patient with suspected duodenal ulcers
Endoscopy + biopsy
88
What would you expect to see on the biopsy of a patient with duodenal ulcers
Brunners gland hypertrophy (to produce more mucus)
89
If you are testing for Helicobacter Pylori infection in a patient with suspected ulcers, what drugs must they not take for 2 weeks prior
Proton pump inhibitor
90
What is the treatment for gastric/ duodenal ulcers if H. Pylori is present
Stop NSAIDS
Tripple therapy:-
Clarythromycin
Amoxicillin
PPI
91
If a patient with H pylori has a penicillin allergy, what drug would you replace in the Tripple therapy
Amoxicillin with metronidazole
92
What is PUD and if found on endoscopy what do you do
Peptic Ulcer Disease (punched-out holes in the stomach or intestine) rescope 6-8 weeks later
93
What artery is at risk to rupture in a patient with duodenal ulcers
Gastroduodenal (lots more common than l gastric rupture in gastric ulcer)
94
What is gastritis
Mucosal inflammation + injury
95
What are 6 causes of gastritis
Autoimmune, H. Pylori, NSAIDS (no inflammation), mucosal ischemia, campylobacter (associated with Guilain-Barre), viral
96
What are the symptoms of gastritis
Epigastric pain with diarrhoea, N+V, indigestion
97
Gold standard test for gastritis
Endoscopy
98
What would be the 1st line investigation for gastritis if H. pylori is suspected
Stool antigen test
Urea breath test
99
What is the treatment for gastritis caused by H. pylori
Triple CAP therapy
Clarithromycin
Amoxicillin
PPI
100
What disorder is autoimmune gastritis associated with
Pernicious anaemia (B12/ folate deficiency)
101
What is the most common cause of gastritis
Campylobacter Jejuni
102
What cells of the stomach does autoimmune gastritis especially affect and what does it do
Atrophy of parietal cells
103
Does an H. pylori infection usually cause diahhroea
No
104
What is appendicitis
An inflamed appendix usually due to lumen obstruction
105
What are the causes of appendicitis
Fae colith (hard solidified faeces), lymphoid hyperplasia (of peyer's patches in teens), filarial worms
106
What organism usually infects the blockage in appendicitis
E. Coli
107
What are the symptoms of appendicitis
Umbilical pain which localises to McBurneys point, rebound tenderness and abdominal guarding, pyrexic
108
What are the signs of appendicitis
Rosving:- Press on RLQ causes LLQ pain
Obturator:- internal rotation of thigh pain
Psoas:- lying on left side and extending the right leg is painful
109
What is the gold standard test for appendicitis
CT abdo + pelvis
110
Why should you do a pregnancy test in suspected appendicitis
Rule out ectopic pregnancy
111
What is the treatment for appendicitis
Antibiotics then appendectomy and drain any abscesses
112
Why must you drain abscesses when treating appendicitis
They are resistant to antibiotics as they are walled off (intra-abscess antibiotics can be used)
113
What is a diverticulum
A pouch or pocket in the bowel wall at perforating artery sites, usually ranges in size from 0.5cm-1cm
114
What is diverticulosis
Presence of diverticulum without inflammation or infection (asymptomatic)
115
What is diverticulitis
An inflamed/ infected diverticulum
116
What is diverticular disease
A symptomatic diverticulum
117
What % of diverticulums are asymptomatic
95%
118
What is meckel's diverticulum
A pediatric disorder, failure of obliteration of vitelline duct (most common malformation of gastrointestinal tract)
119
What is the rule of 2s in Meckels diverticulum
2Y/O, 2 inches long, 2ft from the ileocecal valve
120
What scan is used to diagnose Meckels diverticulum
Technitium scan
121
What are the risk factors for diverticula
Ageing, Male, Increase colon pressure, COPD+ chronic cough
122
What is the triad of symptoms of diverticular disease
LLQ pain, constipation, fresh rectal bleeding
123
What is the gold standard investigation for diverticular disease
CT abdo+ pelvis with contrast
124
What is the treatment for diverticulosis
Nothing, watch and wait
125
What is the treatment for diverticular disease
Bulk-forming laxatives, surgery is GS
126
What is the treatment for diverticulitis
Antibiotics (co-amoxiclav), paracetamol, IV fluid and Liquid food
127
What are the complications of diverticular disease,
Spontaneous bacterial peritonitis (SBP), obstructions, fistulae
128
What obstruction is more common, small or large bowel
Small (60-75%) cases
129
What are the causes of small bowel obstruction
Adhesions (mos common), Crohn's (strictures), strangulating hernias, malignancy
130
What are the signs/ symptoms of small bowel obstruction
First vomiting then constipation
Mild abdo distention + pain
Tinkling bowel sounds
131
What are the causes of large bowel obstruction
Malignancy (most common), volvulus- abnormal twisting(mainly sigmoid, children), intussusception (mc in children)
132
What % of large bowel obstruction is due to malignancy
90%
133
What are the signs/ symptoms of large bowel obstruction
First constipation then vomiting,
Gross distention + pain
Hyperactive then normal then absent bowel sounds
134
What is the 1st line investigation for small/ large bowel obstruction
XR:- Dialated bowel loops + transluminal fluid-gas shadows
135
What is a coffee bean sign
On XR showing sigmoid volvulus
136
What is the GS investigation for bowel obstruction
CT abdo
137
What is the treatment for bowel obstruction
Fluids
NG tube with free drainage
Antiemetics (prevent vomitin) + analgesia
Antibiotics
Surgery is the last resort
138
What is diarrhoea
3+ watery stools daily which are 5-7 on bristol stool chart
139
What are the lengths of acute, sub-acute and chronic diarrhoea
14,14-28, 28+ days
140
What are the causes of diarrhoea
IBD
Coeliac disease
Hyperthyroidism
Inflammation or malignancy
Infective (bacterial or viral)
141
Is diarrhoea caused by a virus or bacteria more common
Virus
142
What is the most common virus causing diarrhoea in kids and adults
Kids (under 3y/o):- rota virus
Adults:- norovirus
143
What bacteria can cause diarrhoea and which is the most common
Campylobacter MC
C. difficile
E. coli
Salmonella
Shigella
Cholera
144
What is bloody diarrhoea known as
Dysentery
145
What antibiotics increase the risk of C. difficile infection
The C's
Co-amoxiclav
Ciprofloxacin
Cephalosporin
Clindamycin
146
What is the main complication to worry about in diarrhoea
Dehydration + electrolyte loss
147
What are the 2 types of oesophageal cancer
Adenocarcinoma lower 2/3
Squamous cell carcinoma upper 2/3
148
Sx of oesophageal cancer
ALARMS
Anemia
Loss of wt
Anorexic
Recent sudden Sx of worsening
Melenea
Swallowing progressively difficult
149
What is gold standard investigation for oesophageal cancer
Oesophago-gastro-duodenoscopy
150
RF for squamous cell carcinoma of oesophagus
Smockin and alcohol
151
Most common type of gastric carcinoma
Adenocarcinoma
152
Causes of Gastric carcnioma
H. pylori
smoking
CDH-1 Mutation
Pernicious anemia
153
Sx of gastric carinoma
Severe epigastric pain, Anemia, weight loss, progressive dysphagia
Jaundice; liver mets
154
What is it called when an internal organ cancer metastases to the supraclavicular lymph node
Virchows node
155
What is it called when an internal organ cancer metastases to the umbilical lymph node
Sister Mary joseph node
156
GS investigation for Gastric carcinoma
Gastroscopy + biopsy
157
What staging do you use for gastric cancer`
TNM
158
Treatment for gastric cancer
Surgery + ECG chemo regime
159
What two inherited conditions massively increase risk of colorectal polyps
Familial adenomatous polyposis
Hereditary non-polyposis colon cancer
Both auto dom
160
Where does colorectal cancer commonly metastasise too
Liver + lung
161
What type of stoll in colorectal cancer
Bloody and mucusy
162
What screening tool is used for colorectal cancer
FIT test
163
GS test for colorectal cancer
Colonoscopy + biopsy
164
Pathology of h. pylori infection
Decreases in somatostatin
Increase in gastric acid as more gastrin
Urease results in ammonia generation
Decrease in HC03- secretion
165
What Abx can induce a Clostridium difficle infection
Ciprofloxacin, co-amoxiclav, cephalosporins, clindamycin
166
Sx of C. Difficile infection
Very watery diarrhoea and big dehydration
Highly infectious
167
Treatment for C. Diff infection
Vancomycin
168
What is achalasia
Oesophageal dysmotility
169
Sx of achalasia
Non progressive dysphagia
170
What does a barium swallow show in achalasia
Bird beak
171
What other investigation do you do in achalasia other than a barium swallow
Manometry
172
What artery is most commonly affected in mesenteric ischemia
Superior mesenteric thrombosis
173
Sx of mesenteric ischemia
Traid of Central acute severe abdo pain
No Abdo signs on exam (guarding, rebound tenderness)
Rapid hypovolemic shock
174
What pH imbalance occurs in mesenteric ischemia
Metabolic acidosis`
175
Investigation for mesenteric ischemia
CT Angiogram
176
Tx for mesenteric ischemia
Fluid resus, Abx, IV heparin
Infarcted bowel:- surgery
177
What do you see on histology in cytomegalovirus
Owl eye colitis
178
What is an anal fistula
Abnormal track from anus to elsewhere
Typically progresses from perianal abcesses
179
Sx of anal fistula
Bloody/ Mucusy discharge (painful)
180
Tx for anal fistula
Surgical removal + drainage
181
Tx for anal fistula
Surgical removal + drainage
182
Most common cause of anal fissure
Hard feces
183
Sx of anal fissure
Extreme defecation pain + very itchy bum + anal bleeding
184
Treatment for anal fissure
Stoll softening + topical creams
185
Sx of perianal abscess
Pus in stoll
186
Tx for perianal abscess
Surgical removal + drainage
187
Internal vs external haemorrhoids
Internal; originate above internal rectal plexus (dentate line) less painful, may feel incomplete emptying
External; Originate below dentate line, so painful cant sit down
188
Dx of haemorrhoids
Digital rectal exam for external
Proctoscopy for internal
189
Tx for haemorrhoids
Stoll softener
Rubber band ligation
