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Phase 2a Ru > GatroIntestinal > Flashcards

GatroIntestinal Flashcards

1
Q

What cytokines are strongly present in Crohn’s disease

A

TNF-Alpha, IL1,IL6

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2
Q

Most common place for Crohns to affect

A

Terminal Iliuem

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3
Q

Risk Factor for Crohn’s

A

Family history, Jewish, Smoking

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4
Q

How would you describe the inflamation in Crohn’s disease

A

Transmural (affects all 4 layers)

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5
Q

Signs/symptoms of Crohns

A

Pain in RUQ, Malabsorption, B12/ folate/ iron deficiency, gall+ kidney stones, watery diarrhoea

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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

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7
Q

What are the extraintestinal symptoms of Crohns disease

A

Apthous mouth ulcers, uveitis episcleritis, erythema nodosum, pyoderma gangrenosum, spondylararthitis

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8
Q

Is pANCA positive in Crohns or Ulcerative Colitis

A

Ulcerative colitis

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9
Q

What antibodies may be present in crohns

A

ASCA (Anti- Saccharomyces cerevisiae antibodies)

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10
Q

What would you see on endoscopy in crohns

A

Skip lesions, cobblestoning, string sign

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11
Q

What would you see on a biopsy in crohns

A

Transmural inflammation with non-caseating granulomas

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12
Q

How do you treat a flare of crohns

A

Prednisolone + sulfasalazine (given as a suppository)

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13
Q

How do you treat crohns in remission

A

Azathioprine
Methotrexate

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14
Q

How does infliximab help in crohns

A

Anti TNF-alpha

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15
Q

What IL12 and IL23 inhibitor is used to treat crohns

A

Ustekinumab

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16
Q

Is surgery curative in crohns

A

No

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17
Q

What are the complications of crohns disease

A

Fistula, strictures, abscesses, small bowel obstruction

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18
Q

What gene is associated with Ulcerative Colitis

A

HLA B27

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19
Q

What is inflammation of the anus also known as

A

Poctitis

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20
Q

Risk factors for UC

A

Family history, Jewish, Smoking is protective

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21
Q

How would you describe the inflammation in UC

A

Confined to mucosa

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22
Q

Intestinal symptoms of UC

A

Pain in LLQ, Tenesmus (rectal defecation pain), bloody mucusy watery diarrhoea

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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)

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24
Q

What antibody present in UC

A

pANCA is positive as well as a raised fecal calprotectin

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25
Q

What would you see on colonoscopy/ XR in UC

A

Continuous inflammation, ‘Lead Pipe’ sign

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26
Q

What would you see on biopsy in UC

A

Mucosal inflammation with crypt hyperplasia

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27
Q

What scoring system is used to class the severity of flares in UC

A

TRULOVE +WITTS

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28
Q

How do you treat a flare of UC

A

Sulfasalazine (very good) and prednisolone (give first if severe)

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29
Q

How to you treat UC in remisiion

A

Azathioprine
Methotrexate
Cyclosporin

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30
Q

What class of drugs is cyclosporin

A

Calcineurin inhibitor

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31
Q

What monoclonal antibody is used to treat UC

A

Infliximab (Anti TNF-alpha)

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32
Q

What is the curative treatment for UC

A

Colectomy

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33
Q

What is the main complication of UC

A

Toxic Megacolon (the leading cause of death)
This is abnormal dilation of the large colon

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34
Q

What typer hypersensitivity reaction occurs in coeliac disease

A

Type 4 (to gluten)

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35
Q

What genes make people susceptible to coeliac

A

HLADQ2+ DQ8 (95%)

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36
Q

What endocrine disorders is coeliac disease associated with

A

Addison’s and thyroid disorders

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37
Q

What is the pathophysiology of coeliac disease

A

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.

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38
Q

What are the symptoms due to malabsorption in coeliac disease

A

Fe, B-12, Folate deficiency (Anemia)
Steatorrhoea (fatty stool)
Diarrhoea
Weight loss and failure to thrive

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39
Q

Other than malabsorption, what are other signs/ symptoms of celiac disease

A

Dermatitis Herpetiformis:- papular rash on shins+ knees due to IgA deposition (itchy blisters and bumps)

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40
Q

What is the 1st (and 2nd)line test for coeliac disease

A

anti-ttG (best, most specific)
Increased Total IgA (may get false negative in IgA deficient patient
2nd:- EMA

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41
Q

What is the Gold standard/ diagnostic test for coeliac disease (and what would you see)

A

Duodenal biopsy:- crypt hyperplasia + villous atrophy (+ epithelial lymphocyte infiltration) (SPRUE)

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42
Q

What is the treatment for coeliac disease

A

Stop eating gluten + replace vitamins/ mineral deficiency

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43
Q

What should you monitor in someone with coeliac disease

A

Osteoporosis with DEXASCANS

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44
Q

What is tropical SPRUE

A

An enteropathy associated with tropical travel which produces similar SPRUE biopsy to coeliac

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45
Q

What is the treatment for tropical sprue

A

Antibiotics

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46
Q

How long do you have to have GI symptoms with no underlying cause for IBS

A

3+ (related to psychology:- stress, poor diet)

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47
Q

What are the 3 types of IBS

A

IBS-C:- mostly constipation
IBS:-D:- mostly diarrhoea
IBS-M:- mixed constipation and diarrhoea

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48
Q

What are the signs and symptoms of IBS

A

Abdo pain + bloating relieved from defication
Altered stool form/ frequency

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49
Q

How would you exclude coeliac, IBD and infections

A

Coeliac:- serology
IBD:- fecal calprotectin
infections:- ESR/CRP/ blood cultures

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50
Q

Treatment for IBS

A

Conservative:- patient education and reassurance
Moderate:- IBS-C:- laxitives
IBS-D:- antimotility drug
Severe:- TCA (tricyclic antdepressants

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51
Q

What is GORD

A

Gastric reflux due to a decrease in pressure across LOS- causes oesophagitis

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52
Q

What are causes for GORD

A

Increase in intraabdominal pressure:- prego, obesity
Hiatal Hernia
Drugs (anti-muscarinic)
Scleroderma (LOS= scarred)

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53
Q

`What are the symptoms of GORD

A

Heartburn (retrosternal burning chest pain)
Chronic cough+ nocturnal asthma
Dysphagia (difficulty swallowing)
Symptoms worse when laying down

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54
Q

What to do in patients with GORD symptoms but no red flags

A

Go straight to treatment

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55
Q

What are the red flags in GORD

A

Dysphagia, haematemesis (vomiting blood), weight loss

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56
Q

What should you do in red flag GORD patient

A

Endoscopy:- oesophagitis or Barrets oesophagus
Oesophageal manometry:- measure LOS pressure
+ monitor gastric acid pH

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57
Q

Treatment for GORD

A

Conservative lifestyle changes:- Smaller meals , 3+ hours before bed
Proton pump inhibitor (H2RA if CI)
Antacids
Alginates (Gaviscon)

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58
Q

What is a side effect of antacids

A

Diahhroea

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59
Q

What is the last resort treatment for GORD

A

Surgical tightening of LOS; Nissen fundoscopy
Wrap fundus around LOS externally to increase pressure across it

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60
Q

What are the complications of GORD

A

Oesophageal strictures and Barrets oesophagus

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61
Q

What age do you usually have oesophageal strictures in GORD

A

60+

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62
Q

How do you treat oesophageal strictures

A

Oesophageal dilation + PPI

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63
Q

What % of GORD patients develop barrets

A

10%

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64
Q

What cause of GORD is always involved in barrets

A

Hiatal hernia

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65
Q

What epithelia change is seen in Barrets osophegus

A

SSNK to simple columnar

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66
Q

What group of people most at risk to develop Barrets

A

middle-aged Caucasian male with a history of GORD + progressively worsening dysphagia

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67
Q

How do you diagnose Barrets Oesaphgues

A

Biopsy

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68
Q

What is a Mallory Weiss Tear

A

A tear in the mucosal membrane of the LOS due to a sudden increase in intra-abdominal pressure

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69
Q

What is the usual presentation of a Mallory West tear

A

Young male with an acute history of retching (such as after a night out) eventually causing haematemesis

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70
Q

What are the risk factors for a Mallory west tear

A

Alcohol, chronic cough, hyperemesis gravidarum (severe N+V in pregnancy)
NO HISTORY OF LIVER DISEASE/ PULMONARY HYPERTENSION

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71
Q

GS investigation for mallory west tear

A

Endoscopy

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72
Q

Treatment for Mallory west tear

A

Most spontaneously heal within 24hr

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73
Q

What scoring system is used for the severity of an upper GI bleed

A

ROCKALL score

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74
Q

Are gastric ulcers more common in the greater or lesser curvature

A

Lesser

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75
Q

What are 3 causes of gastric ulcer

A

Helicobacter pylori
NSAIDS
Zollinger Ellison syndrome (gastrin producing tumour)

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76
Q

What is zollinger ellison syndrome

A

A pancreatic tumour that produces excess gastrin and thus gastric acid hypersecretion

77
Q

What are the symptoms of gastric ulcers

A

Epigastric pain worse on eating
Typically weight loss

78
Q

What are red flags in patients with gastric/ duodenal ulcers

A

55+, haematemesis, anemia, dyssphagia

79
Q

What investigations do you perform on a patient with suspected gastric ulcers but no red flag symtpoms

A

C-urea breath test (detect helicobacter pylori)
Stool antigen test (detect H. pylori)

80
Q

What investigations do you perform on a patient with suspected gastric ulcers with red-flag symptoms

A

Urgent Endoscopy+ biopsy

81
Q

What artery is at risk from rupture due to gastric ulcers

A

L. Gastric (not very common) (far less likely than a gastroduodenal artery rupture in patients with duodenal ulcers)

82
Q

Are gastric or duodenal ulcers more common

A

Duodenal 66%;33%

83
Q

What is the most common location for a duodenal ulcer

A

D1/D2

84
Q

What is the main cause of duodenal ulcers

A

Helicobacter pylori infection
NSAIDS and ZE more prone to gastric

85
Q

What are the symptoms of duodenal ulcers

A

Epigastric pain worse between meals and better with food
Typically weight gain

86
Q

If there are no red flags, what investigations do you perform on a patient with duodenal ulcers

A

Urea breath test
Stool antigen test

87
Q

If red flags are present, what investigations would you perform on a patient with suspected duodenal ulcers

A

Endoscopy + biopsy

88
Q

What would you expect to see on the biopsy of a patient with duodenal ulcers

A

Brunners gland hypertrophy (to produce more mucus)

89
Q

If you are testing for Helicobacter Pylori infection in a patient with suspected ulcers, what drugs must they not take for 2 weeks prior

A

Proton pump inhibitor

90
Q

What is the treatment for gastric/ duodenal ulcers if H. Pylori is present

A

Stop NSAIDS
Tripple therapy:-
Clarythromycin
Amoxicillin
PPI

91
Q

If a patient with H pylori has a penicillin allergy, what drug would you replace in the Tripple therapy

A

Amoxicillin with metronidazole

92
Q

What is PUD and if found on endoscopy what do you do

A

Peptic Ulcer Disease (punched-out holes in the stomach or intestine) rescope 6-8 weeks later

93
Q

What artery is at risk to rupture in a patient with duodenal ulcers

A

Gastroduodenal (lots more common than l gastric rupture in gastric ulcer)

94
Q

What is gastritis

A

Mucosal inflammation + injury

95
Q

What are 6 causes of gastritis

A

Autoimmune, H. Pylori, NSAIDS (no inflammation), mucosal ischemia, campylobacter (associated with Guilain-Barre), viral

96
Q

What are the symptoms of gastritis

A

Epigastric pain with diarrhoea, N+V, indigestion

97
Q

Gold standard test for gastritis

A

Endoscopy

98
Q

What would be the 1st line investigation for gastritis if H. pylori is suspected

A

Stool antigen test
Urea breath test

99
Q

What is the treatment for gastritis caused by H. pylori

A

Triple CAP therapy
Clarithromycin
Amoxicillin
PPI

100
Q

What disorder is autoimmune gastritis associated with

A

Pernicious anaemia (B12/ folate deficiency)

101
Q

What is the most common cause of gastritis

A

Campylobacter Jejuni

102
Q

What cells of the stomach does autoimmune gastritis especially affect and what does it do

A

Atrophy of parietal cells

103
Q

Does an H. pylori infection usually cause diahhroea

A

No

104
Q

What is appendicitis

A

An inflamed appendix usually due to lumen obstruction

105
Q

What are the causes of appendicitis

A

Fae colith (hard solidified faeces), lymphoid hyperplasia (of peyer’s patches in teens), filarial worms

106
Q

What organism usually infects the blockage in appendicitis

A

E. Coli

107
Q

What are the symptoms of appendicitis

A

Umbilical pain which localises to McBurneys point, rebound tenderness and abdominal guarding, pyrexic

108
Q

What are the signs of appendicitis

A

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
Q

What is the gold standard test for appendicitis

A

CT abdo + pelvis

110
Q

Why should you do a pregnancy test in suspected appendicitis

A

Rule out ectopic pregnancy

111
Q

What is the treatment for appendicitis

A

Antibiotics then appendectomy and drain any abscesses

112
Q

Why must you drain abscesses when treating appendicitis

A

They are resistant to antibiotics as they are walled off (intra-abscess antibiotics can be used)

113
Q

What is a diverticulum

A

A pouch or pocket in the bowel wall at perforating artery sites, usually ranges in size from 0.5cm-1cm

114
Q

What is diverticulosis

A

Presence of diverticulum without inflammation or infection (asymptomatic)

115
Q

What is diverticulitis

A

An inflamed/ infected diverticulum

116
Q

What is diverticular disease

A

A symptomatic diverticulum

117
Q

What % of diverticulums are asymptomatic

A

95%

118
Q

What is meckel’s diverticulum

A

A pediatric disorder, failure of obliteration of vitelline duct (most common malformation of gastrointestinal tract)

119
Q

What is the rule of 2s in Meckels diverticulum

A

2Y/O, 2 inches long, 2ft from the ileocecal valve

120
Q

What scan is used to diagnose Meckels diverticulum

A

Technitium scan

121
Q

What are the risk factors for diverticula

A

Ageing, Male, Increase colon pressure, COPD+ chronic cough

122
Q

What is the triad of symptoms of diverticular disease

A

LLQ pain, constipation, fresh rectal bleeding

123
Q

What is the gold standard investigation for diverticular disease

A

CT abdo+ pelvis with contrast

124
Q

What is the treatment for diverticulosis

A

Nothing, watch and wait

125
Q

What is the treatment for diverticular disease

A

Bulk-forming laxatives, surgery is GS

126
Q

What is the treatment for diverticulitis

A

Antibiotics (co-amoxiclav), paracetamol, IV fluid and Liquid food

127
Q

What are the complications of diverticular disease,

A

Spontaneous bacterial peritonitis (SBP), obstructions, fistulae

128
Q

What obstruction is more common, small or large bowel

A

Small (60-75%) cases

129
Q

What are the causes of small bowel obstruction

A

Adhesions (mos common), Crohn’s (strictures), strangulating hernias, malignancy

130
Q

What are the signs/ symptoms of small bowel obstruction

A

First vomiting then constipation
Mild abdo distention + pain
Tinkling bowel sounds

131
Q

What are the causes of large bowel obstruction

A

Malignancy (most common), volvulus- abnormal twisting(mainly sigmoid, children), intussusception (mc in children)

132
Q

What % of large bowel obstruction is due to malignancy

A

90%

133
Q

What are the signs/ symptoms of large bowel obstruction

A

First constipation then vomiting,
Gross distention + pain
Hyperactive then normal then absent bowel sounds

134
Q

What is the 1st line investigation for small/ large bowel obstruction

A

XR:- Dialated bowel loops + transluminal fluid-gas shadows

135
Q

What is a coffee bean sign

A

On XR showing sigmoid volvulus

136
Q

What is the GS investigation for bowel obstruction

A

CT abdo

137
Q

What is the treatment for bowel obstruction

A

Fluids
NG tube with free drainage
Antiemetics (prevent vomitin) + analgesia
Antibiotics
Surgery is the last resort

138
Q

What is diarrhoea

A

3+ watery stools daily which are 5-7 on bristol stool chart

139
Q

What are the lengths of acute, sub-acute and chronic diarrhoea

A

14,14-28, 28+ days

140
Q

What are the causes of diarrhoea

A

IBD
Coeliac disease
Hyperthyroidism
Inflammation or malignancy
Infective (bacterial or viral)

141
Q

Is diarrhoea caused by a virus or bacteria more common

A

Virus

142
Q

What is the most common virus causing diarrhoea in kids and adults

A

Kids (under 3y/o):- rota virus
Adults:- norovirus

143
Q

What bacteria can cause diarrhoea and which is the most common

A

Campylobacter MC
C. difficile
E. coli
Salmonella
Shigella
Cholera

144
Q

What is bloody diarrhoea known as

A

Dysentery

145
Q

What antibiotics increase the risk of C. difficile infection

A

The C’s
Co-amoxiclav
Ciprofloxacin
Cephalosporin
Clindamycin

146
Q

What is the main complication to worry about in diarrhoea

A

Dehydration + electrolyte loss

147
Q

What are the 2 types of oesophageal cancer

A

Adenocarcinoma lower 2/3
Squamous cell carcinoma upper 2/3

148
Q

Sx of oesophageal cancer

A

ALARMS
Anemia
Loss of wt
Anorexic
Recent sudden Sx of worsening
Melenea
Swallowing progressively difficult

149
Q

What is gold standard investigation for oesophageal cancer

A

Oesophago-gastro-duodenoscopy

150
Q

RF for squamous cell carcinoma of oesophagus

A

Smockin and alcohol

151
Q

Most common type of gastric carcinoma

A

Adenocarcinoma

152
Q

Causes of Gastric carcnioma

A

H. pylori
smoking
CDH-1 Mutation
Pernicious anemia

153
Q

Sx of gastric carinoma

A

Severe epigastric pain, Anemia, weight loss, progressive dysphagia
Jaundice; liver mets

154
Q

What is it called when an internal organ cancer metastases to the supraclavicular lymph node

A

Virchows node

155
Q

What is it called when an internal organ cancer metastases to the umbilical lymph node

A

Sister Mary joseph node

156
Q

GS investigation for Gastric carcinoma

A

Gastroscopy + biopsy

157
Q

What staging do you use for gastric cancer`

A

TNM

158
Q

Treatment for gastric cancer

A

Surgery + ECG chemo regime

159
Q

What two inherited conditions massively increase risk of colorectal polyps

A

Familial adenomatous polyposis
Hereditary non-polyposis colon cancer
Both auto dom

160
Q

Where does colorectal cancer commonly metastasise too

A

Liver + lung

161
Q

What type of stoll in colorectal cancer

A

Bloody and mucusy

162
Q

What screening tool is used for colorectal cancer

A

FIT test

163
Q

GS test for colorectal cancer

A

Colonoscopy + biopsy

164
Q

Pathology of h. pylori infection

A

Decreases in somatostatin
Increase in gastric acid as more gastrin
Urease results in ammonia generation
Decrease in HC03- secretion

165
Q

What Abx can induce a Clostridium difficle infection

A

Ciprofloxacin, co-amoxiclav, cephalosporins, clindamycin

166
Q

Sx of C. Difficile infection

A

Very watery diarrhoea and big dehydration
Highly infectious

167
Q

Treatment for C. Diff infection

A

Vancomycin

168
Q

What is achalasia

A

Oesophageal dysmotility

169
Q

Sx of achalasia

A

Non progressive dysphagia

170
Q

What does a barium swallow show in achalasia

A

Bird beak

171
Q

What other investigation do you do in achalasia other than a barium swallow

A

Manometry

172
Q

What artery is most commonly affected in mesenteric ischemia

A

Superior mesenteric thrombosis

173
Q

Sx of mesenteric ischemia

A

Traid of Central acute severe abdo pain
No Abdo signs on exam (guarding, rebound tenderness)
Rapid hypovolemic shock

174
Q

What pH imbalance occurs in mesenteric ischemia

A

Metabolic acidosis`

175
Q

Investigation for mesenteric ischemia

A

CT Angiogram

176
Q

Tx for mesenteric ischemia

A

Fluid resus, Abx, IV heparin
Infarcted bowel:- surgery

177
Q

What do you see on histology in cytomegalovirus

A

Owl eye colitis

178
Q

What is an anal fistula

A

Abnormal track from anus to elsewhere
Typically progresses from perianal abcesses

179
Q

Sx of anal fistula

A

Bloody/ Mucusy discharge (painful)

180
Q

Tx for anal fistula

A

Surgical removal + drainage

181
Q

Tx for anal fistula

A

Surgical removal + drainage

182
Q

Most common cause of anal fissure

A

Hard feces

183
Q

Sx of anal fissure

A

Extreme defecation pain + very itchy bum + anal bleeding

184
Q

Treatment for anal fissure

A

Stoll softening + topical creams

185
Q

Sx of perianal abscess

A

Pus in stoll

186
Q

Tx for perianal abscess

A

Surgical removal + drainage

187
Q

Internal vs external haemorrhoids

A

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
Q

Dx of haemorrhoids

A

Digital rectal exam for external
Proctoscopy for internal

189
Q

Tx for haemorrhoids

A

Stoll softener
Rubber band ligation

Phase 2a Ru (10 decks)

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