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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
What causes coeliac disease?
genetic predisposition (HLA DQ2/DQ8) + environmental trigger (gluten)
26
What are the symptoms of coeliac disease?
Diarrhoea Steatorrhoea (floaty, smelly, stools) Bloating Abdominal pain Fatigue (can often be due to anaemia) Weight loss due to malabsoprtion Mouth ulcers Dermatitis herpetiformis
27
What is coeliac disease associated with?
other autoimmune disorders ! T1DM, Thyroid disease etc
28
How is coeliac disease investigated?
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
29
How is coeliac disease managed?
gluten free diet ! •DEXA scan to assess osteoporotic risk.
30
What are the complications of coeliac disease?
Osteoporosis Increased risk of small bowel cancer and T cell lymphoma, non-Hodgkin lymphoma, anaemia, malabsorption
31
What is GORD?
condition in which acid refluxes through the lower oesophageal sphincter
32
What causes GORD?
Hiatus hernia, obesity, gastric acid hypersecretion, slow gastric emptying
33
What are the risk factors for GORD?
Caffeine, alcohol, smoking, obesity, male, HH, pregnancy
34
What are the symptoms of GORD?
Dyspepsia/indigestion Epigastric pain Heartburn Belching Hoarse voice Nocturnal cough
35
What are the exacerbating factors for GORD?
following food, laying down, bending over.
36
How do you diagnose GORD?
diagnosis is usually clinical unless there are any RED FLAGS.
37
How is GORD managed?
* 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
38
What are the complications of GORD?
oesophagitis, oesophageal stricture, barrett’s oesophagus and oesophgeal adenocarcinoma !
39
What is Barrett's oesophagus?
premalignant condition caused by chronic exposure of the oesophagus to stomach acid. Leads to metaplastic changes
40
What is the pathophysiology of Barrett's oesophagus?
Non-keratinized stratified squamous epithelium in the lower oesophagus becomes non-ciliated columnar epithelium.
41
How is Barrett's oesophagus treated?
* PPI * Endoscopic ablation with photodynamic therapy, laser therapy or cryotherapy * Surgical resection
42
What are the complications of Barrett's oesophagus?
Oesophageal adenocarcinoma
43
What are the classifications of oesophageal cancer?
Adenocarcinoma, squamous cell carcinoma
44
What are the symptoms of oesophageal cancer?
Initially asymptomatic Difficulty swallowing solids, progessing to liquids Anorexia Reflux Painful swallow Red flags: weight loss, night sweats and fatigue
45
What are the risk factors for oesophageal adenocarcinoma?
Barrett’s oesophagus, smoking and alcohol and affects the lower 1/3rd
46
What are the risk factors for oesophageal squamous cell carcinoma?
hot liquids, smoking, alcohol and affects upper 2/3rds
47
What are peptic ulcers?
ulceration of the mucosa of the stomach (gastric ulcer) or duodenum (duodenal ulcer)
48
What causes peptic ulcers?
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
What are the symptoms of peptic ulcers?
* 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
How do you investigate peptic ulcers?
endoscopy + rapid urease test to check for H.pylori
51
How do you manage peptic ulcers?
* Stop any NSAIDs * PPI’s H.pylori eradication if necessary
52
What are the complications of peptic ulcers?
* Bleeding * Perforation Scarring and strictures
53
What is helicobacter pylori?
: gram negative bacteria
54
What are the tests for H. pylori?
Urea breath test Stool antigen test Rapid urease test Performed during an endoscopy
55
How is H. pylori treated?
TRIPLE THERAPY * PPI (e.g. omeprazole) * 2 antibiotics * E.g. amoxicillin and clartithromycin
56
What is appendicitis?
inflammation of the appendix
57
What causes appendicitis?
Infection trapped in the appendix by obstruction. This obstruction can be caused by : Fecalith, undigested seeds, pinworm infection or lymphoid hyperplasia.
58
What are the symptoms of appendicitis?
* 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
What are the signs of appendicitis?
rovsing’s sign (palpation of the LIF causes pain in the RIF).
60
How is appendicitis diagnosed?
clinical presentation + raised inflammatory markers. US and CT can be used to confirm
61
How is appendicitis managed?
Appendicectomy
62
What are the complications of appendicitis?
Rupture Peritonitis as a result of released faecal and infective material
63
What is a diverticulum?
abnormal sac-like protrusions form the bowel wall
64
What is diverticulosis?
diagnosis of the presence of diverticular. No inflammation or infection
65
What is diverticular disease?
when the patient experiences symptoms
66
What is diverticulitis?
inflammation due to infection of the diverticula
67
What are the risk factors for diverticular disease?
older age, male, low fibre diet, NSAIDS, obesity, smoking
68
How does diverticulosis present?
Asymptomatic
69
Where are diverticula found?
Descending colon
70
How are diverticular diseases investigated?
Diverticulosis is often diagnosed incidentally on colonoscopy or CT scans •In diverticulitis there will be raised inflammatory markers and raised white blood cells
71
How do you manage diverticulosis?
Encourage high fibre diet and lots of fluids Weight loss if overweight
72
What causes small bowel obstruction?
adhesions (most common), hernias
73
What are the symptoms of small bowel obstruction?
Diffuse abdominal pain (higher up in SBO) Early vomiting (green bilious vomiting) Constipation occurs later Tinkling bowel sounds Abdominal distention
74
What causes large bowel obstructions?
malignancy, volvulus, intussusception in 6mnths – 2 years
75
What are the symptoms of large bowel obstructions?
Diffuse abdominal pain (lower in the abdomen) Early absolute constipation and lack of flatulence Later onset vomiting Tinkling bowel sounds Greater abdominal distention
76
How are bowel obstructions investigated?
1st line = abdominal X ray X-ray will show distended loops of abdomen PROXIMAL to the obstruction.
77
How are bowel obstructions managed?
curative management is with surgery to remove the obstruction •Analgesia, fluid resuscitation, antibiotics
78
What are haemorrhoids?
enlarged anal vascular cushions
79
What are the risk factors for haemorrhoids?
pregnancy, obesity, older age, increased intra-abdmonal pressure (weight lifting, chronic cough)
80
What are the symptoms of haemorrhoids?
PAINLESS, BRIGHT RED BLEEDING, constipation, straining
81
How are haemorrhoids treated?
1st line = topical creams 2nd line = rubber band ligation 3rd line = haemorrhoidectomy
82
What are anal fistulae?
abnormal connection between surface of the anal canal and the skin
83
What are the symptoms of anal fistulae?
pain, discharge (blood or mucous), ITCHING !
84
How are anal fistulae treated?
* Surgical : fistulotomy & excision * Drain abscess + Abx if infection
85
What are anal fissures?
tear in the skin of the lower anal canal
86
What causes anal fissures?
hard faeces, spasms
87
What are the symptoms of anal fissures?
EXTREME PAIN on defecation, bleeding
88
How do you treat anal fissures?
* Lifestyle : increased fibre and fluids * Simple analgesia * GTN (glyceryl trinitrate) ointment if symptoms don’t improve
89
What are the risk factors for bowel cancer?
Fx, familial adenomatous polyposis (FAP), HNPCC, IBD, older age, obesity, smoking, alcohol
90
What are the symptoms of bowel cancer?
* Change in bowel habit * Weight loss * Rectal bleeding * Abdo pain
91
How is bowel cancer investigated?
•Screening at GP : FIT test. Gold standard – colonoscopy
92
How is bowel cancer treated?
combination of surgical resection, chemo and radiotherapy
93
What key blood result is seen in bowel cancer?
Carcinoembryonic antigen (CEA)
94
What is an upper GI bleed?
bleeding from the oesophagus, stomach or duodenum
95
What can cause upper GI bleeds?
* Oesophgeal varices * Mallory-Weiss tear * Peptic ulcers * Malignancy in stomach or duodenum
96
What are the symptoms of upper GI bleeds?
haematemesis, melaena, haemodynamic instability, symptoms of underlying cause
97
What is a Mallory-Weiss tear?
tear of the tissue of the lower oesophagus
98
What causes Mallory-Weiss tears?
most often by violent coughing or vomiting
99
What suggests a Mallory-Weiss tear?
Haematemsis following a prolonged period of vomiting
100
How is diverticular disease managed?
Same lifestyle advice Avoid NSAIDs Simple analgesics such as paracetamol Antispasmodics
101
How is diverticulitis managed?
IV antibiotics - co-amoxiclav IV analgesia - avoid opiates and NSAIDs Fluids and avoid solid foods till symptoms improve
102
What are the complications of diverticulitis?
Perforation Peritonitis Abscess Haemorrhage
103
How does diverticular disease present?
Pain in LIF Constipation Diarrhoea Occasional rectal bleeding (fresh bright red blood)
104
How does diverticulitis present?
Fever Pain in LIF Diarrhoea N+V Rectal bleeding Systemically unwell

Phase 2a (25 decks)

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