GI Flashcards
4 features of Crohn’s disease at biopsy?
patchy skip lesions
cobblestone mucosa (due to fibrosis)
deep fissuring ulcers
granuloma
3 features of UC inflammation at biopsy?
cut off
only mucosa
pseudopolyps
(crypt abscesses)
5 presentations of IBD?
abdo tenderness malapsorbtion eg iron deficiency anaemia, etc weight loss blood on DRE blood/mucus in stools diarrhoea urgency / tehesmus mouth ulcers fever, tachycardia
3 extra intestinal features of IBD?
arthritis, anklyosing spondylitis osteoporosis iron deficiency anaemia clubbing uveitis, etc PSC
first line prophylaxis for crohns, and some other options?
azathiopurine
methotrexate
infliximab
laxative and anti-diarrhoeal for IBS?
laxative = loperamide
anti diarrhoeal = linaclotide
What class of antibodies are there in coeliac?
IgA
what is the rash associated with coeliac called?
dermatitis herpatiformis
4 features of coeliac on a duodenal biopsy?
crypt hyperplasia
villous atrophy
increased epithelial lymphocytes
flattened mucosa ‘mosaic’
3 complications of poorly controlled coeliac?
malignancy lymphoma infertility osteoporosis ulcerative jejunitis refractory coeliac disease
what type of epithelium is normally in the:
stomach
oesophagus
what transformation does the oesophageal epithelium undergo in Barrets?
stomach = columnar
oesophagous = squamous
squamous to columnar
causes / risk factors for Barretts oesophagus & GORD?
obesity oesophageal hypermobility gastric acid hypersecretion/zollinger-ellison pregnancy smoking NSAIDs caffeine, alcohol hiatus hernia
What is the difference between Barrett’s and GORD?
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
5 clinical presentations of GORD?
heartburn espesh when lying down regurgitation dyspepsia retrosternal chest pain bloating nocturnal cough hoarse voice dysphagia water brash
5 red flags for GORD that warrant endoscopy?
new onset over 55 weight loss dysphagia upper abdo pain nausea / vomitting refractory anaemia high platelets but anaemia
What are the two most common kinds of oesophageal cancer and some basic epidemiology of them?
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
what is the dysphagia like in oesophageal cancer?
progressive so starting with solids then progresing to liquid
5 clinical presentations in stomach cancer?
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
what is the investigation for ?stomach cancer and what will you see (3)
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 :) )
2 benign colon lesions that can lead to colorectal cancer?
benign adenoma
familial adenomatous polyposis (dominant inheritance = cancer in 20s)
hereditary non polyposis colon cancer (mutation in DNA repair protein)
what is the staging system used for colorectal cancer and what are the stages?
Dukes
A: only submucosa
B: muscular / transmural
C: lymph nodes
D: metastasis
how does right sided colon cancer present?
right sided is hard to find
iron deficiency anaemia due to chronic low level bleeding
how does left sided colon cancer present? 3
rectal bleeding diarrhoea / constipation colicky pain weight loss rectal mass N&V
If the FOB is pos and you suspect colon cancer what inv do you do next?
screening sigmoidoscopy
then if thats pos you can do a full colonoscopy
What is peutz-jeghers syndrome?
mutation in a tumour supressor gene
= polyps in the small bowel
bleeding, intusseption, malignant transformation to cancer
How can the history tell you if its a gastric or duodenal ulcer?
eating - worsens gastric and improves duodenal
3 examples of intraluminal intestinal obstruction?
tumour eg colon cancer diaphragm disease (caused by NSAIDs, = fibrosis) diverticulitis IBS sliding hernia gallstone ileus
3 causes of intramural obstruction?
inflammation - Crohns, diverticulitis
skirous tumour
Hirsprung’s neuropathy
3 causes of extramural intestinal obstruction?
adhesions volvulus intusseption hernia peritoneal tumour
3 non mechanical causes of intestinal obstruction?
paralytic ileus mesenteric thromboembolism pseudo obstruction retroperitoneal haematoma slow transit bowel
4 cardinal features of bowel obstruction?
abdo pain
nausea and vomitting
absolute constipation
distention
how does the presentation of small vs large bowel obstruction differ?
small = acute. bilious feculent vomiting. central pain
large = chronic. constipation. peripheral pain
what is the name of bowel sounds that you can hear without a stethoscope?
borborygmi
Two signs of a large intestine volvulus on imaging?
whorl in mesentery on CT
coffee bean on x ray (= sigmoid colon is affected)
what does jejenum distention look like on abdo x ray?
volvuli columnentis (stack of coins)
if you see ‘shouldering’ on an abdo CT what does this mean?
cancer
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
first line investigations (2) for ?appendicitis?
CT abdo / pelvis + contrast
USS/ hCG to exclude preg
CRP
gold standard inv for appendicitis?
CT scan
3 differentials for appendicitis?
ectopic preg
ovarian cysts
Meckle’s diverticulum
mesenteric adenitis
where is the most common place for diverticulae to form?
sigmoid colon
guarding, rebound or percussion tenderness on an abdo exam suggests?
perforation/peritonitis
what imaging is best to look for diverticulosis?
CT abdo and pelvis with contrast
best abx for diverticulitis in primary care?
co amoxiclav
2 complications of diverticular disease?
perforation – peritonitis
haemorrhage
fistula: colon-bladder / colon-vagina
ileus / bowel obstruction
3 aetiology of gastritis?
H pylori pernicious anaemia Crohns ischaemia CMV, HSV duodenogastric reflux (bile salts from SI into stomach) NSAIDs alcohol/caffeine/smoking
presentation of gastritis? 4 features
nausea/vom bloating epigastric pain indigestion haematemesis malaena
how do GI hormones/enzymes change in gastritis?
gastrin raised
pepsinogen decreased
Treatment for H pylori? 3
metronidazole
quinolone / clarithromycin
lansoprazole
2nd line: + bismuth subsalicylate
3rd line: + rifabutin (and take away the abx)
what are the two most vulnerable places to ischaemia?
- splenic flexure
2. rectosigmoidal junction
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
investigation for ischaemic colitis & chronic mesenteric ischaemia?
IC: CT without contrast - thumbprinting
MI: CT angiography with contrast
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
what is a peri-anal fistula?
abnormal connection between anal canal & surrounding skin
from abscess, Crohns
what is a perianal fissure?
tear in anal canal
childbirth, hard faeces, crohns
bleeding
sharp pain when passing stools
what is Parks classification for?
peri anal fistula
what is the most common type of anorectal abcess?
peri anal
where is iron absorbed?
duodenum
where is B12 absorbed?
terminal ileum
where is folate absorbed?
jejunum
duodenum
what is autoimmune gastritis?
affects corpus and fundus of stomach
loss of oxynctic glands = hypochlorrhydia
lack of parietal cells = pernicious anaemia
can ischaemia cause ulcers?
yes
because the mucus producing cells die off, and cant produce mucus to protect the underlying cells
where is the most common location for colorectal cancer?
rectum
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
chronic cough difficulty swallowing and sometimes aspirates badbreath midline gurgling throat lump what is this?
pharyngeal pouch
achalasia dysphagia?
achalasia = difficulty with solids and liquids from start
difficulty initiating swallow suggests ..
bulbar palsy
what node is lumpy in stomach cancer?
Virchow’s
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
where is a mallory weiss tear?
gastro-oesophageal junction
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
what things suggest inflammatory diarrhoea?
severe blood tenesmus fever mucus abdo pain
what is the pain like in small bowel obstruction?
severe
colicky
intermittent
what on an abdo x ray confirms small bowel obstruction?
dilated jejunum/ileum
absence of gas distal to obstruction
volvuli columnentis
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
complications of small bowel obstruction which would need surgery?
bowel ischaemia
strangulation
describe the two types of haemorrhoids?
internal: painless, reducible, covered in mucus
external: in the anal opening painful and covered by skin
complications of diverticulitis? 4
excessive bleeding
perforation leading to peritonitis
large bowel obstruction
colon-vaginal fistula
what is the drug for burst oesophageal varices?
IV terlepressin
somatostatin = 2nd line
