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Phase 2a > GI > Flashcards

GI Flashcards

1
Q

What is inflammatory bowel disease?

A

An umbrella term for Crohn’s disease and Ulcerative Colitis.

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2
Q

What is Crohn’s disease?

A

A chronic inflammatory condition affecting the GIT.

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3
Q

What is Ulcerative Colitis?

A

A chronic inflammatory condition affecting the colon and rectum.

Involves the formation of ulcers.

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4
Q

What are the protective factors for ulcerative colitis?

A

Smoking

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5
Q

What are the risk factors for ulcerative colitis?

A
  • Age (under 30)
  • White
  • Family history
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6
Q

What are the risk factors for Crohn’s?

A
  • Age (under 30)
  • White
  • Family history
  • Smoking
  • Female
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7
Q

What are the symptoms of ulcerative colitis?

A
  • Bloody diarrhoea (can be with mucus)
  • Abdo pain and discomfort
  • Faecal urgency
  • Systemic symptoms
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8
Q

What are the symptoms of Crohn’s?

A
  • Diarrhoea (not bloody)
  • Faecal urgency
  • Abdo pain
  • Systemic symptoms
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9
Q

What are the signs of ulcerative colitis?

A

Tender, distended abdomen

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10
Q

What are the signs of Crohn’s?

A
  • Aphthous ulcers
  • Abdo tenderness
  • Right iliac fossa mass
  • Perianal abscess
  • Anal/rectal strictures
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11
Q

What investigations are done for suspected ulcerative colitis?

A
  • Bloods (FBC, CRP, cultures)
  • LFTs
  • Stool tests (MCS and C Diff)
  • AXR
  • CXR
  • CT
  • Ileocolonoscopy
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12
Q

What are the differential diagnoses for IBD?

A

Other causes of diarrhoea:
- Salmonella
- Giardia intestinalis
- Rotavirus

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13
Q

What is the aim of treatment for ulcerative colitis?

A

Induce remission.

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14
Q

What is the treatment for mild/moderate ulcerative colitis?

A
  • Oral 5-aminosalicylic acid (5-ASA)
  • Rectal 5-ASA
  • Glucocorticoid if not responsive
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15
Q

Give 3 examples of 5-ASAs.

A
  • Sulfasalazine
  • Mesalazine
  • Olsalazine
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16
Q

What is the treatment for severe ulcerative colitis?

A

Glucocorticoid (eg. oral prednisolone)

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17
Q

What is the management of Crohn’s disease?

A
  • Smoking cessation
  • Anaemia (iron, B12 or folate deficiency) should be treated with replacement
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18
Q

How is a mild attack of Crohn’s managed?

A

Controlled-release corticosteroids (budesonide)

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19
Q

How is a moderate attack of Crohn’s managed?

A

Glucocorticoids (oral prednisolone)

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20
Q

How is a severe attack of Crohn’s managed?

A
  • IV hydrocortisone
  • Treat rectal disease
  • Antibiotics
  • Anti-TNF
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21
Q

How is remission maintained in Crohn’s?

A

Azathioprine (methotrexate if intolerant)

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22
Q

What are the complications of ulcerative colitis?

A
  • Toxic megacolon
  • Bleeding
  • Malignancy
  • Strictures (leading to obstruction)
  • Venous thrombosis
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23
Q

What are the complications of Crohn’s?

A
  • Fistulae
  • Strictures
  • Abscesses
  • Malabsorption
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24
Q

What is irritable bowel syndrome?

A

A mixed group of abdominal symptoms with no organic cause.

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25
Q

What are the three types of IBS?

A
  • IBS-C
  • IBS-D
  • IBS-M
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26
Q

What is the pathophysiology of irritable bowel syndrome?

A

Dysfunction in the brain-gut axis results in disorder of intestinal motility and/or enhanced visceral perception.

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27
Q

What are the causes of IBS?

A
  • Depression/anxiety
  • Psychological stress/trauma
  • GI infection
  • Sexual, physical and verbal abuse
  • Eating disorders
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28
Q

What are the risk factors for IBS?

A
  • Female
  • Previous severe and long diarrhoea
  • High hypochondriacal anxiety
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29
Q

When should IBS be considered?

A

ABC:
- Abdo pain
- Bloating
- Change in bowel habits

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30
Q

What is the diagnostic criteria for IBS?

A
  1. Abdo discomfort including two of:
    - Relieved by defecation
    - Change in stool frequency
    - Change in stool formation
  2. Accompanied by two of:
    - Urgency
    - Abdo bloating/distension
    - Worsening symptoms after food
    - Incomplete evacuation
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31
Q

What is the exclusion criteria for IBS?

A
  • > 40 years old
  • Bloody stool
  • Anorexia
  • Weight loss
  • Diarrhoea at night
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32
Q

What investigations are ordered for suspected IBS?

A
  • FBC
  • ESR
  • LFTs
  • Coeliac serology
  • TSH
  • Colonoscopy
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33
Q

What is the management for IBS?

A
  • Exclusion diets
  • Bulking agents for constipation and diarrhoea
  • Antispasmodics for colic/bloating
  • CBT
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34
Q

What is Coeliac disease?

A

A condition in which there is inflammation of the mucosa of the upper small bowel that improves when gluten is withdrawn from the diet and relapses when gluten is reintroduced.

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35
Q

What is the clinical presentation of coeliac disease?

A

GLIAD:
- GI malabsorption
- Lymphoma and carcinoma
- Immune associations
- Anaemia
- Dermatological

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36
Q

What investigations are ordered in suspected coeliac disease?

A
  • Bloods (FBC, LFTs, INR etc)
  • Antibodies
  • Stool tests
  • Oesophago-gastro-duodenoscopy (OGD)
  • Duodenal biopsy
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37
Q

What are the differential diagnoses for coeliac disease?

A
  • Peptic duodenitis
  • Crohn’s
  • Giardiasis
  • Post-gastroenteritis
  • Eosinophilic enteritis
  • Graft-versus-host disease
  • Non-coeliac gluten insensitivity
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38
Q

What is the management of coeliac disease?

A
  • Gluten-free diet
  • Pneumococcal vaccine
  • Dermatitis herpertiformis
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39
Q

What are the complications of coeliac disease?

A
  • Malabsorption
  • Malnutrition
  • Lactose intolerance
  • Cancer
  • Pregnancy complications
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40
Q

What is gastro-oesophageal reflux disease? (GORD)

A

Acid from the stomach leaks up into the oesophagus.

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41
Q

What are the risk factors for GORD?

A
  • Hiatus hernia
  • Smoking
  • Alcohol
  • Obesity
  • Pregnancy
  • Drugs
  • Iatrogenic
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42
Q

What are the signs and symptoms of GORD?

A
  • Heartburn
  • Belching
  • Odonophagia
  • Dysphagia
  • Nocturnal asthma
  • Chronic cough
  • Laryngitis
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43
Q

What are the investigations for GORD?

A

PPI trial

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44
Q

What are the differential diagnoses for GORD?

A
  • ACS
  • Stable angina
  • Functional oesophageal disorder
  • Functional dyspepsia
  • PUD
  • Malignancy
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45
Q

What is the conservative management of GORD?

A
  • Weight loss
  • Raise head of bed
  • Small regular meals
  • Smoking cessation
  • Avoid hot drinks and spicy foods
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46
Q

What is the medical management of GORD?

A
  • OTC antacids
  • PPI (lansoprazole)
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47
Q

What is the surgical management of GORD?

A

Nissen fundoplication.

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48
Q

What are the complications of GORD?

A
  • Oesophagitis
  • PUD
  • Barret’s metaplasia
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49
Q

What is a Mallory-Wiess tear?

A

A tear/laceration along the right border of (or near) the gastro-oesophageal junction.

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50
Q

What is the pathophysiology of a Mallory-Weiss tear?

A

Not completely understood.

Thought to be high abdominal pressure with low intrathoracic pressure.

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51
Q

What are the risk factors for a Mallory-Weiss tear?

A
  • Alcoholism
  • Forceful vomiting
  • Eating disorders
  • Male
  • NSAID use
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52
Q

What are the clinical features of a Mallory-Weiss tear?

A
  • Vomiting
  • Haematemesis after vomiting
  • Retching
  • Postural hypotension
  • Dizziness
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53
Q

How is a Mallory-Weiss tear diagnosed?

A

OGDoscopy

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54
Q

What are the differential diagnoses for a Mallory-Weiss tear?

A
  • Gastroenteritis
  • Peptic ulcer
  • Cancer
  • Oesophageal varices
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55
Q

How are Mallory-Weiss tears managed?

A
  • Normally self-limiting
  • Supportive care
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56
Q

What are peptic ulcers?

A

AKA gastric ulcers - open sores in the lining of the stomach

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57
Q

How are peptic ulcers classified?

A

Acute and chronic.

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58
Q

What are the causes of acute peptic ulcers?

A
  • Drugs (NSAIDs, steroids)
  • Stress
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59
Q

What are the causes of chronic peptic ulcers?

A
  • Drugs
  • H. pylori
  • High calcium
  • Zollinger-Ellison
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60
Q

What is the main difference between duodenal and gastric ulcer pathophysiology?

A

Duodenal - too much acid
Gastric - not enough acid protection

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61
Q

What are the risk factors for duodenal ulcers?

A
  • H pylori
  • Drugs
  • Smoking
  • Alcohol
  • Increased gastric emptying
  • Blood group O
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62
Q

What are the risk factors for gastric ulcers?

A
  • H pylori
  • Smoking
  • Drugs
  • Delayed gastric emptying
  • Stress
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63
Q

What is the clinical presentation of duodenal ulcers?

A

Epigastric pain (before meals, relieved by eating or milk).

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64
Q

What is the clinical presentation of gastric ulcers?

A
  1. Epigastric pain
    - Worse on eating
    - Relieved by antacids
  2. Weight loss
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65
Q

What investigations are ordered for suspected peptic ulcer disease?

A
  • Upper GI endoscopy
  • H. pylori C13 urea breath test/stool antigen test
  • FBC
66
Q

What are the differential diagnoses for PUD?

A
  • Oesophageal cancer
  • Stomach cancer
  • GORD
  • Gastroparesis
  • Biliary colic
  • Acute pancreatitis
  • IBS
67
Q

What is the conservative management of peptic ulcer disease?

A
  • Lose weight
  • Smoking and alcohol cessation
  • Avoid hot drinks/spicy food
  • Stop drugs (NSAIDs and steroids)
68
Q

What is the medical management of peptic ulcer disease?

A
  • OTC antacids
  • H/ pylori eradication (CAP)
  • Full dose acid suppression
  • Low dose acid suppression
69
Q

What are the complications of peptic ulcers?

A
  • Haemorrhage
  • Perforation
  • Gastric outflow obstruction
  • Malignancy
70
Q

What is appendicitis?

A

Inflammation of the vermiform appendix ranging from oedema to ischaemic necrosis and perforation.

71
Q

What is the pattern of abdo pain in appendicitis?

A
  1. Early inflammation
    - Appendiceal irritation
    - Visceral pain not well localised
    - Umbilical pain
  2. Late inflammation
    - Parietal peritoneum irritation
    - Pain localised in the right iliac fossa
72
Q

What are the symptoms of appendicitis?

A
  • Colicky abdo pain
  • Anorexia
  • Nausea
  • Constipation/diarrhoea
73
Q

What are the signs of appendicitis?

A
  • Low-grade pyrexia
  • Tachycardia
  • Dyspnoea
  • Guarding and tenderness at McBurney’s point
  • Rovsings sign
  • Psoas sign
  • Cope sign
74
Q

What is Rovsing’s sign?

A

Pressure in LIF - more pain in RIF

75
Q

What is Psoas sign?

A

Pain on extending the hip - rectocaecal appendix.

76
Q

What is Cope sign?

A

Flexion and internal rotation of R hip - pain

77
Q

How is appendicitis diagnosed?

A

Clinical

78
Q

What investigations should be ordered for appendicitis?

A
  • FBC
  • CRP
  • Abdo ultrasound
  • Contrast-enhanced abdo CT
79
Q

What are the differential diagnoses for appendicitis?

A
  • Cholecystitis
  • Diverticulitis
  • Ruptured ectopic
  • Cyst accident (torsion, rupture, haemorrhage)
  • Crohn’s
80
Q

What is the management of appendicitis?

A
  • Fluids
  • Antibodies
  • Analgesia
  • Appendectomy
81
Q

What are the complications of appendicitis?

A
  • Appendix mass
  • Appendix abscess
  • Perforation
82
Q

What is a diverticulum?

A

Out-pouching of tubular structure.

83
Q

What is a true diverticulum?

A

Composed of a complete wall.

84
Q

What is a false diverticulum?

A

Composed of mucosa only.

85
Q

What is diverticular disease?

A

Symptomatic diverticulosis.

86
Q

What is diverticulitis?

A

Inflammation of diverticula.

87
Q

What is the clinical presentation of diverticular disease?

A
  • Altered bowel habits
  • Nausea
  • Flatulence
  • Abdo pain and tenderness
  • Pyrexia
88
Q

What investigations should be ordered for diverticular disease?

A
  • FBC (polymorphonuclear leukocytes)
  • CRP (elevated)
89
Q

What are the differential diagnoses of diverticular disease?

A
  • Endometriosis
  • Colorectal
  • Appendicitis
  • Ulcerative colitis
  • Crohn’s
  • Ischaemic colitis
  • IBS
90
Q

How is diverticular disease managed?

A
  • Bowel rest (nil by mouth)
  • Abs
  • IV fluids
  • Analgesia
  • Surgery
91
Q

What are the complications of diverticular disease?

A
  • Abscess
  • Perforation
  • Haemorrhage
  • Fistulae
  • Strictures
92
Q

What is gastritis?

A

Inflammation associated with mucosal injury.

93
Q

What are the causes of gastritis?

A
  • H. pylori infection
  • Autoimmune gastritis
  • Viruses (CMV, HSV)
  • Duodenogastric reflux
  • Crohn’s
  • NSAIDs/aspirin
94
Q

What is the clinical presentation of gastritis?

A
  • Nausea
  • Vomiting
  • Abdo bloating
  • Epigastric pain
  • Indigestion
  • Haematemesis
95
Q

How is gastritis diagnosed?

A
  • Endoscopy
  • Biopsy
  • H. pylori urea breath test
  • H. pylori antigen stool test
96
Q

What are the differential diagnoses for gastritis?

A
  • PUD
  • GORD
  • Non-ulcer dysplasia
  • Gastric lymphoma
  • Gastric carcinoma
97
Q

What is the treatment for gastritis?

A
  • Remove causative agents
  • Reduce stress
  • H. pylori eradication
  • H2 antagonists
  • PPIs
  • Antacids
98
Q

What is the pathophysiology of a small bowel obstruction?

A

Most commonly mechanical obstruction (adhesion, hernia, Crohn’s)

99
Q

What are the causes of small bowel obstruction?

A
  • Adhesions (previous abdo surgery)
  • Hernia
  • Malignancy
  • Crohn’s
100
Q

How does small bowel obstruction present?

A
  • Pain (colicky then diffuse)
  • Profuse vomiting (that follows pain)
  • Less distension than LBO
  • Nausea
  • Anorexia
  • Tenderness
101
Q

What investigations are done for small bowel obstruction?

A
  • AXR (central gas shadows)
  • Examination of hernia orifices
  • Rectal exam
  • FBC
  • CT (gold standard)
102
Q

What are the differentials for small bowel obstruction?

A
  • Ileus
  • Infectious gastroenteritis
  • Large bowel obstruction
  • Intestinal pseudo-obstruction
  • Acute appendicitis
  • Acute pancreatitis
103
Q

What is the management of small bowel obstruction?

A
  • Aggressive fluid resuscitation
  • Bowel decompression
  • Analgesia
  • Antibiotics
  • Antiemetics
  • Surgery (remove obstruction)
104
Q

What are the complications of small bowel obstruction?

A
  • Intestinal necrosis
  • Sepsis
  • Multi-organ failure
  • Intestinal perforation
105
Q

What is the pathophysiology of large bowel obstruction?

A

The colon proximal to the obstruction dilates, increasing colonic pressure and decreasing mesenteric blood flow.

106
Q

What causes large bowel obstructions?

A

Colorectal malignancy (90%)

107
Q

How does large bowel obstruction present?

A
  • Abdo pain and distension
  • Palpable mass
  • Late vomiting
  • Constipation
  • Bloating
  • Nausea
108
Q

What investigations are done for large bowel obstruction?

A
  • Digital rectal exam
  • FBC
  • AXR
  • CT
109
Q

What are the differentials for large bowel obstruction?

A
  • Acute colonic pseudo-obstruction
  • Chronic megacolon
  • Toxic megacolon
  • Endometriosis
  • Pseudomembranous colitis
110
Q

What is the management of large bowel obstruction?

A
  • Aggressive fluid resuscitation
  • Bowel decompression
  • Analgesia
  • Antibiotics
  • Surgery
111
Q

What are the possible complications of large bowel obstruction?

A
  • Bowel perforation
  • Sepsis
  • Death
112
Q

What is intestinal pseudo-obstruction?

A
  • Clinical picture mimics obstruction
  • No mechanical cause
113
Q

What causes intestinal pseudo-obstruction?

A

Complications of other conditions

114
Q

What is the clinical presentation of intestinal pseudo-obstruction?

A

Rapid and progressive abdo distension and pain.

115
Q

What investigations are done for intestinal pseudo-obstruction?

A

AXR (gas-filled large bowel)

116
Q

What is the management for intestinal pseudo-obstruction?

A
  • Treat underlying cause
  • IV neostigmine
117
Q

What are the 2 types of oesophageal cancers and where do they occur?

A
  • Squamous cell carcinoma (middle and upper third)
  • Adenocarcinomas (lower third)
118
Q

What are the causes of oesophageal squamous cell carcinoma?

A
  • High levels of alcohol consumption
  • Achalasia
  • Smoking
  • Tobacco use
  • Obesity
  • Low fruit and veg
119
Q

What are the causes of oesophageal adenocarcinomas?

A
  • Smoking
  • Tobacco use
  • GORD
  • Obesity
120
Q

What are the protective factors against oesophageal squamous cell carcinoma?

A

Diet rich in:
- Fibre
- Carotenoids
- Folate
- Vit C

121
Q

What are the risk factors for oesophageal cancers?

A
  • Alcohol
  • Smoking
  • Obesity
  • Achalasia
  • Diet low in Vit A and C
  • Barrett’s oesophagus
122
Q

What is the clinical presentation of oesophageal cancers?

A
  • Progressive dysphasia
  • Weight loss
  • Lymphadenopathy
  • Anorexia
  • Pain
  • Difficulty swallowing
  • Hoarseness and cough
123
Q

What are the clinical features of benign oesophageal tumours?

A
  • Usually asymptomatic
  • Dysphagia
  • Retrosternal pain
  • Food regurgitation
  • Recurrent chest infections
124
Q

How are oesophageal cancers diagnosed?

A
  • Oesophagoscopy with biopsy
  • Barium swallow
  • CT scan/MRI/PET for staging
125
Q

How are benign oesophageal tumours diagnosed?

A
  • Endoscopy
  • Barium swallow
  • Biopsy to rule out malignancy
126
Q

How are oesophageal cancers treated?

A
  • Surgical resection
  • Systemic chemo if incurable/metastases
127
Q

How are benign oesophageal tumour managed?

A
  • Endoscopic removal
  • Surgical removal of larger tumours
128
Q

What are the two types of gastric cancer?

A
  • Intestinal (type 1)
  • Diffuse (type 2)
129
Q

What are the features of intestinal gastric adenocarcinomas?

A
  • Well formed and differentiated glandular structures
  • Tumours are polypoid or ulcerating lesions
  • Intestinal metaplasia is seen in the surrounding mucosa
130
Q

What are the features of diffuse gastric adenocarcinomas?

A
  • Poorly cohesive undifferentiated cells
  • Tend to infiltrate the gastric wall
  • Can involve the cardia
  • Worse prognosis than intestinal
131
Q

What are the causes of gastric adenocarcinomas?

A
  • Smoking
  • H. pylori infection
  • Diet
  • Loss of p53 and APC genes
  • Family history
  • Pernicious anaemia
132
Q

What are the protective factors against gastric adenocarcinomas?

A
  • Non-starchy vegetables
  • Fruit
  • Garlic
  • Low salt
133
Q

What are the risk factors for gastric adenocarcinomas?

A
  • First-degree relative with gastric cancer
  • Smoking
  • Dietary factors
134
Q

What is the clinical presentation of gastric adenocarcinomas?

A
  • Epigastric pain
  • Nausea
  • Anorexia
  • Weight loss
  • Vomiting
  • Dysphagia
135
Q

Where can a gastric adenocarcinoma metastasise?

A
  • Liver (jaundice)
  • Bone
  • Lung
  • Brain
136
Q

How is gastric adenocarcinoma diagnosed?

A
  • Gastroscopy and biopsy
  • Endoscopic ultrasound (evaluate depth of invasion)
  • CT/MRI for staging
  • PET scan (mets)
137
Q

How is a gastric adenocarcinoma managed?

A
  • Nutritional support
  • Surgery and combination chemo
138
Q

What are the risk factors for small intestine cancer?

A
  • Coeliac disease
  • Crohn’s disease
139
Q

What is the clinical presentation for small intestine cancer?

A
  • Pain
  • Diarrhoea
  • Anorexia
  • Weight loss
  • Anaemia
  • Palpable mass in cases
140
Q

How is small intestine cancer diagnosed?

A
  • US
  • Endoscopic biopsy
141
Q

What is the treatment for small intestine cancer?

A
  • Surgical resection
  • Radiotherapy
142
Q

What is a colonic polyp?

A

Abnormal growth of tissue projecting from colonic mucosa.

143
Q

What are adenomas in the colon?

A
  • A type of polyp
  • Precursor lesions in most cases
  • Benign, dysplastic tumour of columnar cell/glandular tissue
144
Q

What are the two types of inherited polyps?

A
  • Familial adenomatous polyposis
  • Lynch syndrome (Hereditary Non-Polyposis Colon Cancer)
145
Q

What is the most common colorectal carcinoma?

A

Adenocarcinoma.

146
Q

Where do most colorectal carcinomas occur?

A

Distal colon.

147
Q

What is the progression of colorectal adenomas?

A

Normal epithelium - adenoma - colorectal adenocarcinoma

Spreads by infiltration through the bowel wall and then spread to lymphatic and BVs.

148
Q

What are the risk factors for colorectal carcinomas?

A
  • Age
  • Low fibre diet
  • High sugar and red meat diet
  • Colorectal polyps
  • Alcohol
  • Smoking
  • Obesity
  • UC
  • Family history
149
Q

What are the protective risk factors for colorectal carcinomas?

A
  • Vegetables
  • Milk
  • Garlic
  • Exercise
  • Low-dose aspirin
150
Q

How do polyps in the rectum or sigmoid colon present?

A

Bleeding.

151
Q

How do right sided colorectal carcinomas present?

A
  • Usually asymptomatic until anaemia due to bleeding
  • May have a mass
  • Weight loss
  • Low Hb
  • Abdo pain
152
Q

How do left sides colorectal carcinomas present?

A
  • Change in bowel habit
  • Blood and mucus in stool
  • Alternating constipation and diarrhoea
  • Thin/altered stool
153
Q

How do rectal carcinomas present?

A
  • Rectal bleeding and mucus
  • Thinner stool and tenesmus (cramping rectal pain)
154
Q

What is an emergency presentation of colorectal carcinomas?

A

Obstruction

155
Q

What are the 4 cardinal signs bowel obstruction?

A
  • Absolute constipation
  • Colicky abdominal pain
  • Abdominal distension
  • Vomiting (faeculent)
156
Q

How are colorectal carcinomas diagnosed?

A
  • Faecal occult blood (FOB)
  • Colonoscopy (gold standard)
  • MRI
157
Q

How are colorectal carcinomas classified as per the Duke’s classification?

A

A = Limited to muscularis mucosae (95% 5-year survival)
B = Extension through MM (75%)
C = Involvement of regional metastases (35%)
D = Distant metastases (6.6%)

158
Q

What are the differential diagnoses for colorectal carcinomas?

A
  • Anorectal pathology (haemorrhoids, anal fissure/prolapse)
  • Colonic pathology (IBD, diverticular disease)
  • Small intestine and stomach pathology (GI bleed)
159
Q

How are bowel polyps managed?

A

Removed to reduce risk of developing into cancer.

160
Q

What is the treatment for colorectal carcinomas?

A
  • Surgery if no mets
  • Endoscopic stenting
  • Radiotherapy
  • Chemotherapy (if Duke C post op)

Phase 2a (11 decks)

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