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GI Flashcards

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1
Q

4 features of Crohn’s disease at biopsy?

A

patchy skip lesions
cobblestone mucosa (due to fibrosis)
deep fissuring ulcers
granuloma

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2
Q

3 features of UC inflammation at biopsy?

A

cut off
only mucosa
pseudopolyps
(crypt abscesses)

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3
Q

5 presentations of IBD?

A 
abdo tenderness 
malapsorbtion eg iron deficiency anaemia, etc 
weight loss 
blood on DRE
blood/mucus in stools 
diarrhoea 
urgency / tehesmus 
mouth ulcers 
fever, tachycardia
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4
Q

3 extra intestinal features of IBD?

A 
arthritis, anklyosing spondylitis 
osteoporosis 
iron deficiency anaemia
clubbing 
uveitis, etc 
PSC
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5
Q

first line prophylaxis for crohns, and some other options?

A

azathiopurine

methotrexate
infliximab

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6
Q

laxative and anti-diarrhoeal for IBS?

A

laxative = loperamide

anti diarrhoeal = linaclotide

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7
Q

What class of antibodies are there in coeliac?

A

IgA

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8
Q

what is the rash associated with coeliac called?

A

dermatitis herpatiformis

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9
Q

4 features of coeliac on a duodenal biopsy?

A

crypt hyperplasia
villous atrophy
increased epithelial lymphocytes
flattened mucosa ‘mosaic’

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10
Q

3 complications of poorly controlled coeliac?

A 
malignancy
lymphoma 
infertility
osteoporosis 
ulcerative jejunitis 
refractory coeliac disease
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11
Q

what type of epithelium is normally in the:
stomach
oesophagus
what transformation does the oesophageal epithelium undergo in Barrets?

A

stomach = columnar
oesophagous = squamous
squamous to columnar

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12
Q

causes / risk factors for Barretts oesophagus & GORD?

A 
obesity
oesophageal hypermobility
gastric acid hypersecretion/zollinger-ellison 
pregnancy
smoking
NSAIDs
caffeine, alcohol 
hiatus hernia
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13
Q

What is the difference between Barrett’s and GORD?

A

GORD = reflux of the stomach contents into the oesophagus, through the gastro-oesophageal sphincter

persistent GORD causes Barrett’s, which is a premalignant transformation from squamous to columnar epithelium

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14
Q

5 clinical presentations of GORD?

A 
heartburn espesh when lying down
regurgitation
dyspepsia
retrosternal chest pain
bloating 
nocturnal cough
hoarse voice
dysphagia
water brash
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15
Q

5 red flags for GORD that warrant endoscopy?

A 
new onset over 55
weight loss
dysphagia
upper abdo pain
nausea / vomitting 
refractory 
anaemia 
high platelets but anaemia
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16
Q

What are the two most common kinds of oesophageal cancer and some basic epidemiology of them?

A

adenocarcinoma = common here - GORD/fat smoking man. at the bottom of the oesoph

squamous cell carcinoma = common in Japan. nitrosamines, hot drinks and achlasia. top of the oesoph

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17
Q

what is the dysphagia like in oesophageal cancer?

A

progressive so starting with solids then progresing to liquid

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18
Q

5 clinical presentations in stomach cancer?

A 
iron deficiency anaemia
mass 
malaena 
acanthosis nigrans (black armpits)
troiser's sign: enlarged hard left supraclavicular node 
early satiety

nausea
dyspepsia
weight loss, anorexia
abdo pain

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19
Q

what is the investigation for ?stomach cancer and what will you see (3)

A

upper GI endoscopy with biopsy

ulcer with heaped edges
leinitis plastica (leatherbottle stomach)
poor inflation in response to the endoscopy/barium meal
fibrosis
may be HER2 pos (then you can treat with trastuzumab :) )

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20
Q

2 benign colon lesions that can lead to colorectal cancer?

A

benign adenoma
familial adenomatous polyposis (dominant inheritance = cancer in 20s)
hereditary non polyposis colon cancer (mutation in DNA repair protein)

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21
Q

what is the staging system used for colorectal cancer and what are the stages?

A

Dukes

A: only submucosa
B: muscular / transmural
C: lymph nodes
D: metastasis

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22
Q

how does right sided colon cancer present?

A

right sided is hard to find

iron deficiency anaemia due to chronic low level bleeding

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23
Q

how does left sided colon cancer present? 3

A 
rectal bleeding 
diarrhoea / constipation 
colicky pain 
weight loss 
rectal mass 
N&V
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24
Q

If the FOB is pos and you suspect colon cancer what inv do you do next?

A

screening sigmoidoscopy

then if thats pos you can do a full colonoscopy

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25
What is peutz-jeghers syndrome?
mutation in a tumour supressor gene = polyps in the small bowel bleeding, intusseption, malignant transformation to cancer
26
How can the history tell you if its a gastric or duodenal ulcer?
eating - worsens gastric and improves duodenal
27
3 examples of intraluminal intestinal obstruction?
``` tumour eg colon cancer diaphragm disease (caused by NSAIDs, = fibrosis) diverticulitis IBS sliding hernia gallstone ileus ```
28
3 causes of intramural obstruction?
inflammation - Crohns, diverticulitis skirous tumour Hirsprung's neuropathy
29
3 causes of extramural intestinal obstruction?
``` adhesions volvulus intusseption hernia peritoneal tumour ```
30
3 non mechanical causes of intestinal obstruction?
``` paralytic ileus mesenteric thromboembolism pseudo obstruction retroperitoneal haematoma slow transit bowel ```
31
4 cardinal features of bowel obstruction?
abdo pain nausea and vomitting absolute constipation distention
32
how does the presentation of small vs large bowel obstruction differ?
small = acute. bilious feculent vomiting. central pain large = chronic. constipation. peripheral pain
33
what is the name of bowel sounds that you can hear without a stethoscope?
borborygmi
34
Two signs of a large intestine volvulus on imaging?
whorl in mesentery on CT coffee bean on x ray (= sigmoid colon is affected)
35
what does jejenum distention look like on abdo x ray?
volvuli columnentis (stack of coins)
36
if you see 'shouldering' on an abdo CT what does this mean?
cancer
37
What are the symptoms & abdo exam findings in appendicitis?
``` abdo pain. epigastric -- RIF Tenderness @ McBurneys point Rosvig sign. press LIF = RIF pain anorexia nausea/vom ```
38
first line investigations (2) for ?appendicitis?
CT abdo / pelvis + contrast USS/ hCG to exclude preg CRP
39
gold standard inv for appendicitis?
CT scan
40
3 differentials for appendicitis?
ectopic preg ovarian cysts Meckle's diverticulum mesenteric adenitis
41
where is the most common place for diverticulae to form?
sigmoid colon
42
guarding, rebound or percussion tenderness on an abdo exam suggests?
perforation/peritonitis
43
what imaging is best to look for diverticulosis?
CT abdo and pelvis with contrast
44
best abx for diverticulitis in primary care?
co amoxiclav
45
2 complications of diverticular disease?
perforation -- peritonitis haemorrhage fistula: colon-bladder / colon-vagina ileus / bowel obstruction
46
3 aetiology of gastritis?
``` H pylori pernicious anaemia Crohns ischaemia CMV, HSV duodenogastric reflux (bile salts from SI into stomach) NSAIDs alcohol/caffeine/smoking ```
47
presentation of gastritis? 4 features
``` nausea/vom bloating epigastric pain indigestion haematemesis malaena ```
48
how do GI hormones/enzymes change in gastritis?
gastrin raised | pepsinogen decreased
49
Treatment for H pylori? 3
metronidazole quinolone / clarithromycin lansoprazole 2nd line: + bismuth subsalicylate 3rd line: + rifabutin (and take away the abx)
50
what are the two most vulnerable places to ischaemia?
1. splenic flexure | 2. rectosigmoidal junction
51
What is the difference between ischaemic colitis and mesenteric ischaemia?
ischaemic colitis = large bowel ischaemia. pain but not too severe. usually non occlusive eg hypotension, shock mesenteric ischaemia = occlusion of the superior mesenteric artery. associated with AF, etc. super bad pain if acute, if chronic lose loads of weight cos so painful to eat
52
investigation for ischaemic colitis & chronic mesenteric ischaemia?
IC: CT without contrast - thumbprinting MI: CT angiography with contrast
53
what is a pilondal sinus & how does it normally develop?
in the natal cleft a tunnel forms under the skin male age 18-30 sitting a lot with thick hair and deep natal cleft :S
54
what is a peri-anal fistula?
abnormal connection between anal canal & surrounding skin | from abscess, Crohns
55
what is a perianal fissure?
tear in anal canal childbirth, hard faeces, crohns bleeding sharp pain when passing stools
56
what is Parks classification for?
peri anal fistula
57
what is the most common type of anorectal abcess?
peri anal
58
where is iron absorbed?
duodenum
59
where is B12 absorbed?
terminal ileum
60
where is folate absorbed?
jejunum | duodenum
61
what is autoimmune gastritis?
affects corpus and fundus of stomach loss of oxynctic glands = hypochlorrhydia lack of parietal cells = pernicious anaemia
62
can ischaemia cause ulcers?
yes because the mucus producing cells die off, and cant produce mucus to protect the underlying cells
63
where is the most common location for colorectal cancer?
rectum
64
what is the marsh categorisation for and what is each level?
coeliac = intraepithelial lymphocytes ``` 1 - lymphocytes NO crypt hyperplasia 2 - crypt hyperplasia 3a - crypt hyperplasia, mild villous atrophy 3b - subtotal/moderate villous atrophy 3c total villous atrophy ```
65
``` chronic cough difficulty swallowing and sometimes aspirates badbreath midline gurgling throat lump what is this? ```
pharyngeal pouch
66
achalasia dysphagia?
achalasia = difficulty with solids and liquids from start
67
difficulty initiating swallow suggests ..
bulbar palsy
68
what node is lumpy in stomach cancer?
Virchow's
69
classic presentation of haemorrhoids?
fresh blood and mucus in stools anus is itchy and sore but no pain when passing stools risk factors - obesity, constipation, coughing etc
70
where is a mallory weiss tear?
gastro-oesophageal junction
71
what is the gold standard investigation for acute flare of diverticulitis?
contrast CT colonography you would see in on a colonscopy but not first line bc its invasive, especially in acute flare we dont want that
72
what things suggest inflammatory diarrhoea?
``` severe blood tenesmus fever mucus abdo pain ```
73
what is the pain like in small bowel obstruction?
severe colicky intermittent
74
what on an abdo x ray confirms small bowel obstruction?
dilated jejunum/ileum absence of gas distal to obstruction volvuli columnentis
75
what is the supportive management of small intestine obstruction? (before surgery)
``` nil by mouth nasogastric tube to decompress bowel IV fluids + electrolytes anti emetics urinary catheter ```
76
complications of small bowel obstruction which would need surgery?
bowel ischaemia | strangulation
77
describe the two types of haemorrhoids?
internal: painless, reducible, covered in mucus external: in the anal opening painful and covered by skin
78
complications of diverticulitis? 4
excessive bleeding perforation leading to peritonitis large bowel obstruction colon-vaginal fistula
79
what is the drug for burst oesophageal varices?
IV terlepressin somatostatin = 2nd line

phase 2a (10 decks)

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