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Phase 2a > GI > Flashcards

GI Flashcards

1
Q

What are the key GI symptoms?

A
  • Abdominal pain
  • Diarrhoea
  • Constipation
  • PR bleeding
  • Vomiting
  • Weight loss
  • Fatigue
  • Dyspepsia
  • Dysphagia
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2
Q

How is the abdomen divided?

A
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3
Q

What does pain in each division of the abdomen indicate?

A
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4
Q

What is IBD?

A

Inflammation in part of the GI tract due to an autoimmune reaction

•2 conditions : ulcerative colitis and crohn’s disease

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5
Q

What causes IBD?

A

Abnormal autoimmune reaction

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6
Q

What are the risk factors for IBD?

A
  • Crohn’s : smoking and family history
  • UC : family history
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7
Q

How is IBD investigated?

A

Bloods

CRP (will be raised due to active inflammation)

Faecal calprotectin = SCREENING TEST

Colonoscopy with biopsy = DIAGNOSTIC

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8
Q

What is Crohn’s disease?

A

transmural inflammation of ANY part of the GI tract (mouth-anus).

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9
Q

What is a risk factor for Crohn’s disease?

A

SMOKING.

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10
Q

What is the pathophysiology of Crohn’s?

A

Inflammation is NOT continuous -> creates skip lesions. Discrete areas of inflammation throughout the colon.

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11
Q

What are the symptoms of Crohn’s?

A

Polyarticular arthritis

Erythema nodosum

Aphthous mouth ulcers

Episcleritis

Generalised abdominal pain

Diarrhoea

Non specific -> fatigue, malaise, anorexia, weight loss

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12
Q

How is Crohn’s managed?

A
  • Inducing remission -> 1st line are steroids (e.g. prednisolone)
    • DMARDS such azathioprine or methotrexate
  • Maintaining remission -> 1st line are DMARDS such as azathioprine or mercaptopurine
  • 2nd line is methotrexate
  • If neither work start introducing biological medications such as infliximab or adalimumab
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13
Q

What is ulcerative colitis?

A

Continuous, superficial inflammation limited to the rectum and the colon.

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14
Q

What is a protective factor for ulcerative colitis?

A

Smoking

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15
Q

What is the pathophysiology of ulcerative colitis?

A

Inflammation is limited the intestinal mucosa

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16
Q

What are the symptoms of ulcerative colitis?

A

BLOODY diarrhoea

Faecal urgency

Tenesmus

Generalised abdominal pain

PRIMARY SCLEROSING CHOLANGITIS

The rest are identical to Crohn’s

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17
Q

How is ulcerative colitis managed?

A
  • Inducing remission -> 1st line aminosalicylate (e.g. mesalazine)
  • 2nd line corticosteroids (e.g. prednisolone)
  • 3rd line addition of calcineurin inhibitors if needed (e.g. ciclosporin)
  • Maintaining remission
  • Aminosalicylate
  • Azathioprine

Mercaptopurine

Surgery for UC can be curative due to the limited effect in the rectum and colon -> panproctocolectomy

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18
Q

What are the key features of Crohn’s?

A

Crows NESTS

  • N : no blood or mucus
  • E : entire GI tract
  • S : skip lesions on endoscopy
  • T : TERMINAL ileum most affected and TRANSMURAL inflammation
  • S : smoking is a risk factor
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19
Q

What are the key features of ulcerative colitis?

A
  • CLOSEUP
  • C : continuous inflammation
  • L : limited to the colon and the rectum
  • O : only the superficial mucosa is affected
  • S : smoking is protective
  • E : excrete blood and mucus
  • U : use aminosalicylates
  • P : primary sclerosing cholangitis
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20
Q

What is IBS?

A

FUNCTIONAL bowel disorder causing recurrent abdominal pain with abnormal bowel motility causing constipation and/or diarrhoea

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21
Q

What are the symptoms of IBS?

A
  • A : Abdominal pain RELIEVED BY DEFECATION
  • B : Bloating
  • C : Change in bowel habit (constipation and/or diarrhoea)
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22
Q

How is IBS investigated?

A

Bloods (including coeliac serology and CRP for inflammation).

Faecal calprotectin

Colonoscopy

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23
Q

How is IBS treated?

A

Diet modification

For diarrhea: loperamide

For constipation: soluble fibers and laxatives

For spasms and pain: anti-spasmodics

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24
Q

What is Coeliac disease?

A

Chronic autoimmune condition where exposure to gluten causing inflammation within the small bowel

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25
Q

What causes coeliac disease?

A

genetic predisposition (HLA DQ2/DQ8) + environmental trigger (gluten)

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26
Q

What are the symptoms of coeliac disease?

A

Diarrhoea

Steatorrhoea (floaty, smelly, stools)

Bloating

Abdominal pain

Fatigue (can often be due to anaemia)

Weight loss due to malabsoprtion

Mouth ulcers

Dermatitis herpetiformis

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27
Q

What is coeliac disease associated with?

A

other autoimmune disorders ! T1DM, Thyroid disease etc

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28
Q

How is coeliac disease investigated?

A

Ensure patient maintains gluten diet for 6 wks before tests

Coeliac serology

1st check for raised IgA anti-TTG antibodies

Second raised anti-endomysial antibodies

Gold standard = duodenal endoscopy + biopsy - villous atrophy, crypt hyperplasia and increased epithelial WBCs

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29
Q

How is coeliac disease managed?

A

gluten free diet !

•DEXA scan to assess osteoporotic risk.

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30
Q

What are the complications of coeliac disease?

A

Osteoporosis

Increased risk of small bowel cancer and T cell lymphoma, non-Hodgkin lymphoma, anaemia, malabsorption

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31
Q

What is GORD?

A

condition in which acid refluxes through the lower oesophageal sphincter

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32
Q

What causes GORD?

A

Hiatus hernia, obesity, gastric acid hypersecretion, slow gastric emptying

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33
Q

What are the risk factors for GORD?

A

Caffeine, alcohol, smoking, obesity, male, HH, pregnancy

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34
Q

What are the symptoms of GORD?

A

Dyspepsia/indigestion

Epigastric pain

Heartburn

Belching

Hoarse voice

Nocturnal cough

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35
Q

What are the exacerbating factors for GORD?

A

following food, laying down, bending over.

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36
Q

How do you diagnose GORD?

A

diagnosis is usually clinical unless there are any RED FLAGS.

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37
Q

How is GORD managed?

A
  • Lifestyle : reduce caffeine and alcohol, smaller lighter meals, weight loss
  • Rennie and Gaviscon when needed.
  • 1st line medication = PPI (omeprazole, lansoprazole)
  • 2nd line medication = H2 receptor antagonist such as ranitidine
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38
Q

What are the complications of GORD?

A

oesophagitis, oesophageal stricture, barrett’s oesophagus and oesophgeal adenocarcinoma !

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39
Q

What is Barrett’s oesophagus?

A

premalignant condition caused by chronic exposure of the oesophagus to stomach acid. Leads to metaplastic changes

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40
Q

What is the pathophysiology of Barrett’s oesophagus?

A

Non-keratinized stratified squamous epithelium in the lower oesophagus becomes non-ciliated columnar epithelium.

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41
Q

How is Barrett’s oesophagus treated?

A
  • PPI
  • Endoscopic ablation with photodynamic therapy, laser therapy or cryotherapy
  • Surgical resection
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42
Q

What are the complications of Barrett’s oesophagus?

A

Oesophageal adenocarcinoma

43
Q

What are the classifications of oesophageal cancer?

A

Adenocarcinoma, squamous cell carcinoma

44
Q

What are the symptoms of oesophageal cancer?

A

Initially asymptomatic

Difficulty swallowing solids, progessing to liquids

Anorexia

Reflux

Painful swallow

Red flags: weight loss, night sweats and fatigue

45
Q

What are the risk factors for oesophageal adenocarcinoma?

A

Barrett’s oesophagus, smoking and alcohol and affects the lower 1/3rd

46
Q

What are the risk factors for oesophageal squamous cell carcinoma?

A

hot liquids, smoking, alcohol and affects upper 2/3rds

47
Q

What are peptic ulcers?

A

ulceration of the mucosa of the stomach (gastric ulcer) or duodenum (duodenal ulcer)

48
Q

What causes peptic ulcers?

A

Loss of the protective layer due to medications such as NSAIDs or h. pylori infection

Increased acid production due to stress, alcohol, caffeine, smoking, spicy foods

49
Q

What are the symptoms of peptic ulcers?

A
  • Epigastric pain/discomfort
  • Gastric ulcer -> pain is worse following food !
  • Duodenal ulcer -> pain is worse before eating, improves following food
  • N&V
  • Dyspepsia
  • Faigue, due to iron deficiency anaemia
  • If the peptic ulcer bleeds :
  • Hematemesis -> ‘coffee ground’ vomit
  • Melaena
50
Q

How do you investigate peptic ulcers?

A

endoscopy + rapid urease test to check for H.pylori

51
Q

How do you manage peptic ulcers?

A
  • Stop any NSAIDs
  • PPI’s

H.pylori eradication if necessary

52
Q

What are the complications of peptic ulcers?

A
  • Bleeding
  • Perforation

Scarring and strictures

53
Q

What is helicobacter pylori?

A

: gram negative bacteria

54
Q

What are the tests for H. pylori?

A

Urea breath test

Stool antigen test

Rapid urease test

Performed during an endoscopy

55
Q

How is H. pylori treated?

A

TRIPLE THERAPY

  • PPI (e.g. omeprazole)
  • 2 antibiotics
  • E.g. amoxicillin and clartithromycin
56
Q

What is appendicitis?

A

inflammation of the appendix

57
Q

What causes appendicitis?

A

Infection trapped in the appendix by obstruction. This obstruction can be caused by :

Fecalith, undigested seeds, pinworm infection or lymphoid hyperplasia.

58
Q

What are the symptoms of appendicitis?

A
  • Umbilical pain initially that then radiates the the right lower quadrant (McBurney’s point).
  • 2/3rds of the way from the umbilicus to the anterior superior iliac spine
  • N&V
  • Fever

Anorexia

59
Q

What are the signs of appendicitis?

A

rovsing’s sign (palpation of the LIF causes pain in the RIF).

60
Q

How is appendicitis diagnosed?

A

clinical presentation + raised inflammatory markers. US and CT can be used to confirm

61
Q

How is appendicitis managed?

A

Appendicectomy

62
Q

What are the complications of appendicitis?

A

Rupture

Peritonitis as a result of released faecal and infective material

63
Q

What is a diverticulum?

A

abnormal sac-like protrusions form the bowel wall

64
Q

What is diverticulosis?

A

diagnosis of the presence of diverticular. No inflammation or infection

65
Q

What is diverticular disease?

A

when the patient experiences symptoms

66
Q

What is diverticulitis?

A

inflammation due to infection of the diverticula

67
Q

What are the risk factors for diverticular disease?

A

older age, male, low fibre diet, NSAIDS, obesity, smoking

68
Q

How does diverticulosis present?

A

Asymptomatic

69
Q

Where are diverticula found?

A

Descending colon

70
Q

How are diverticular diseases investigated?

A

Diverticulosis is often diagnosed incidentally on colonoscopy or CT scans

•In diverticulitis there will be raised inflammatory markers and raised white blood cells

71
Q

How do you manage diverticulosis?

A

Encourage high fibre diet and lots of fluids

Weight loss if overweight

72
Q

What causes small bowel obstruction?

A

adhesions (most common), hernias

73
Q

What are the symptoms of small bowel obstruction?

A

Diffuse abdominal pain (higher up in SBO)

Early vomiting (green bilious vomiting)

Constipation occurs later

Tinkling bowel sounds

Abdominal distention

74
Q

What causes large bowel obstructions?

A

malignancy, volvulus, intussusception in 6mnths – 2 years

75
Q

What are the symptoms of large bowel obstructions?

A

Diffuse abdominal pain (lower in the abdomen)

Early absolute constipation and lack of flatulence

Later onset vomiting

Tinkling bowel sounds

Greater abdominal distention

76
Q

How are bowel obstructions investigated?

A

1st line = abdominal X ray

X-ray will show distended loops of abdomen PROXIMAL to the obstruction.

77
Q

How are bowel obstructions managed?

A

curative management is with surgery to remove the obstruction

•Analgesia, fluid resuscitation, antibiotics

78
Q

What are haemorrhoids?

A

enlarged anal vascular cushions

79
Q

What are the risk factors for haemorrhoids?

A

pregnancy, obesity, older age, increased intra-abdmonal pressure (weight lifting, chronic cough)

80
Q

What are the symptoms of haemorrhoids?

A

PAINLESS, BRIGHT RED BLEEDING, constipation, straining

81
Q

How are haemorrhoids treated?

A

1st line = topical creams

2nd line = rubber band ligation

3rd line = haemorrhoidectomy

82
Q

What are anal fistulae?

A

abnormal connection between surface of the anal canal and the skin

83
Q

What are the symptoms of anal fistulae?

A

pain, discharge (blood or mucous), ITCHING !

84
Q

How are anal fistulae treated?

A
  • Surgical : fistulotomy & excision
  • Drain abscess + Abx if infection
85
Q

What are anal fissures?

A

tear in the skin of the lower anal canal

86
Q

What causes anal fissures?

A

hard faeces, spasms

87
Q

What are the symptoms of anal fissures?

A

EXTREME PAIN on defecation, bleeding

88
Q

How do you treat anal fissures?

A
  • Lifestyle : increased fibre and fluids
  • Simple analgesia
  • GTN (glyceryl trinitrate) ointment if symptoms don’t improve
89
Q

What are the risk factors for bowel cancer?

A

Fx, familial adenomatous polyposis (FAP), HNPCC, IBD, older age, obesity, smoking, alcohol

90
Q

What are the symptoms of bowel cancer?

A
  • Change in bowel habit
  • Weight loss
  • Rectal bleeding
  • Abdo pain
91
Q

How is bowel cancer investigated?

A

•Screening at GP : FIT test.

Gold standard – colonoscopy

92
Q

How is bowel cancer treated?

A

combination of surgical resection, chemo and radiotherapy

93
Q

What key blood result is seen in bowel cancer?

A

Carcinoembryonic antigen (CEA)

94
Q

What is an upper GI bleed?

A

bleeding from the oesophagus, stomach or duodenum

95
Q

What can cause upper GI bleeds?

A
  • Oesophgeal varices
  • Mallory-Weiss tear
  • Peptic ulcers
  • Malignancy in stomach or duodenum
96
Q

What are the symptoms of upper GI bleeds?

A

haematemesis, melaena, haemodynamic instability, symptoms of underlying cause

97
Q

What is a Mallory-Weiss tear?

A

tear of the tissue of the lower oesophagus

98
Q

What causes Mallory-Weiss tears?

A

most often by violent coughing or vomiting

99
Q

What suggests a Mallory-Weiss tear?

A

Haematemsis following a prolonged period of vomiting

100
Q

How is diverticular disease managed?

A

Same lifestyle advice

Avoid NSAIDs

Simple analgesics such as paracetamol

Antispasmodics

101
Q

How is diverticulitis managed?

A

IV antibiotics - co-amoxiclav

IV analgesia - avoid opiates and NSAIDs

Fluids and avoid solid foods till symptoms improve

102
Q

What are the complications of diverticulitis?

A

Perforation

Peritonitis

Abscess

Haemorrhage

103
Q

How does diverticular disease present?

A

Pain in LIF

Constipation

Diarrhoea

Occasional rectal bleeding (fresh bright red blood)

104
Q

How does diverticulitis present?

A

Fever

Pain in LIF

Diarrhoea

N+V

Rectal bleeding

Systemically unwell

Phase 2a (25 decks)

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