Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

2a - SBCS > GI > Flashcards

GI Flashcards

1
Q

What is inflammatory bowel disease (IBD)

A

Umbrella term for 2 main diseases causing inflammation of the GI tract
* Ulcerative Colitis (UC)
* Crohn’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define UC

A

Autoimmune condition causing excessive inflammation of mucosa in the colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe the inflammation in UC

A
  • Starts from rectum
  • Continuous inflammation
  • Confined to superficial mucosa
  • Only affects colon/rectum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How does smoking affect UC

A

Smoking is protective in UC
I.e smoking is associated with a lower risk of having UC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

RFs of UC

A
  • NSAIDs
  • FHx
  • Jewish
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Give 4 factors that may trigger a flare in UC

A

stress
medications: NSAIDs, antibiotics
cessation of smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Signs and symptoms of UC

A
  • Abdo pain usually in left lower quadrant
  • Blood and mucous in stool
  • Bloody diarrhoea
  • Tenesmus - needing to pass stool even tho bowels are empty
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which gene is UC associated with

A

HLA B27 gene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What type of UC has inflammation in the entire bowel

A

pancolitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe the investigation of UC

A
  • GS: Colonoscopy + biopsy
    Depletion of goblet cells
    No inflammation beyond mucosa
    Crypt abscesses
  • Faecal calprotectin stool test - +ve (non-specific)
  • pANCA (perinuclear anti-neutrophilic cytoplasmic Ab) - +ve
  • CRP/ESR - inflammation and active disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When is faecal calprotectin released

A

Released by the intestines when inflamed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Treatment of mild/ moderate UC

A
  1. topial rectal Aminosalicylate (mesalazine)
  2. if remission not achieved within 4 weeks, add on oral aminosalicylate
  3. add on topical/ oral Corticosteroids (prednisolone)
    - stop topical treatment in proctosigmoiditis and left-sided ulcerative colitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Treatment for severe UC

A

Should be treated in hospital
1. IV steroid - e.g. hydrocortisone
2. No improvement after 72hrs: consider adding IV ciclosporin or consider surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the gold standard treatment of UC

A

Colectomy = curative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How is remission maintained in UC

A

proctitis and proctosigmoiditis:
* topical (rectal) aminosalicylate alone OR
* oral aminosalicylate plus a topical (rectal) aminosalicylate OR
* oral aminosalicylate by itself
left-sided and extensive ulcerative colitis:
* low maintenance dose of an oral aminosalicylate
severe relapse or >=2 exacerbations in the past year:
* oral azathioprine or oral mercaptopurine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe the histological features of inflammation in Crohn’s

A
  • Transmural
  • Granulomatous (skip lesions)
  • Affects any part of the GI tracts
  • inflammation in all layers from mucosa to serosa
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the most common site affected by Crohn’s disease

A

terminal ileum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How does smoking affect Crohn’s

A

Doubles risk of developing Crohn’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Signs and symptoms of Crohn’s

A
  • Abdo pain usually in right lower quadrant (ileum)
  • diarrhoea usually non bloody
  • Malabsorption - weight loss, fatigue
  • Mouth ulcers
  • perianal disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Explain the pathophysiology of Crohn’s

A
  • Faulty GI epithelium = pathogen invasion
  • Exaggerated inflammatory response
  • Formation of granuloma and destruction of GI tissues
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Describe the investigation of Crohn’s

A
  • Endoscopy and colonoscopy: skip lesions, cobblestone appearance
  • Biopsy: Transmural inflammation with granulomas
  • pANCA: -ve
  • Raised faecal calprotectin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Features suggestive of Crohn’s on small bowel enema

A

strictures: ‘Kantor’s string sign’
proximal bowel dilation
‘rose thorn’ ulcers
fistulae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How is remission induced in Crohn’s

A
  1. glucocorticoids (oral, topical or intravenous)
    * Oral prednisolone
    * IV hydrocortisone
    * Oral budesonide as alternative
  2. 5-ASA drugs (e.g. mesalazine)
  3. Azathioprine, mercaptopurine or methotrexate may be used as an add-on medication
  4. Infliximab is used in refractory disease and fistulating Crohn’s
    * metronidazole for isolated peri-anal disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How is remission maintained in Crohn’s

A
  • stop smoking
  • 1st line: azathioprine or mercaptopurine (+TPMT activity should be assessed before starting)
  • 2nd line: methotrexate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the investigation of choice for suspected perianal fistulae in Crohn’s

A

MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Describe the role of surgery in Crohn’s disease

A
  • ileocaecal resection
  • segmental small bowel resections
  • perianal abscess: incision and drainage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are some complications of Crohn’s

A
  • Fistula - abnormal open connection
  • Fissures - crack in the lining
  • Strictures - narrowing due to thickened wall
  • anaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Signs of extraintestinal IBD

A
  • Ankylosing spondylitis - inflamed spine
  • Pyoderma gangrenosum - painful skin ulcers
  • Uveitis - mc in UC
  • Erythema nodosum - swollen fat under skin = dark bumps/ patches
  • primary Sclerosing cholangitis - much mc in UC
  • Pyoderma gangrenosum
  • Clubbing
  • arthritis - mc
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Define irritable bowel syndrome

A

A chronic functional bowel disorder
* no identifiable organic disease underlying the symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

RFs of IBS

A
  • Female
  • Younger age (20-30)
  • Anxiety
  • PTSD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the 3 main types of IBS

A
  • IBS-C = constipation
  • IBS-D = diarrhoea
  • IBS-M = Alternated between C and D
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Signs and symptoms of IBS

A
  • Abdominal pain - relieved from defecation
  • Bloating
  • Change in bowel habit
  • Symptoms are worse after eating
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Describe the investigation and diagnosis of IBS

A

Rule out differentials:
* Faecal calprotectin -ve to exclude IBD
* -ve coeliac disease serology
* Normal FBC, ESR & CRP
Diagnosis:
* Recurrent abdo pain at least once a week for last 3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Describe the conservative management of IBS

A
  • Patient education
  • Low FODMAP diet
  • Limit caffeine and alcohol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are FODMAPs

A

Short-chain carbs that are poorly absorbed in the GIT:
Fermentable Oligosaccharides, Disaccharides, Monosaccharides and
Polyols

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Describe the medical management of IBS

A
  • Diarrhoea - loperamide
  • Constipation - laxatives (avoid lactulose due to bloating)
  • Antispasmodic for cramps - hyoscine butylbromide
  • Tricyclic antidepressants - amitriptyline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is coeliac disease

A

Autoimmune condition where exposure to gluten causes mucosal inflammation in the small bowel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Name the 2 main autoantibodies associated with coeliac disease

A
  • Anti -tissue transglutaminase (anti-TTG)
  • Anti-endomysial (anti-EMA)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What 2 genes are associated with coeliac diseae

A
  • HLA-DQ2 (90%)
  • HLA-DQ8
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Explain the pathophysiology of coeliac disease

A
  • Auto-antibodies (anti-TTG and anti-EMA) are created in response to exposure to gluten
  • These target epithelial cells of the SI and lead to inflammation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

How does inflammation affect the small intestine in coeliac disease

A
  • Affects particularly the jejunum
  • Villous atrophy
  • Crypt hyperplasia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What type of antibodies are anti-TTG and anti-EMA

A

IgA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Signs and symptoms of coeliac disease

A
  • Dermatitis herpetiformis - itchy blistering skin rash caused by IgA deposition in dermis
  • Diarrhoea and recurrent abdo pain
  • Failure to thrive in kids
  • Anaemia secondary to iron, folate or B12 deficiency
  • Weight loss and fatigue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Describe the investigation and diagnosis of coeliac disease

A

Investigations must be carried out while patient remains on a diet containing gluten
* Check for total IgA levels to exclude deficiency
* 1st line: raised anti-TTG
* 2nd: raised anti-EMA
* GS: Endoscopy and duodenal biopsy: crypt hyperplasia, villous atrophy and intraepithelial lymphocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Why is it important to test for total IgA levels in coeliac disease

A
  • anti-TTG and anti-EMA are IgA
  • If the patient has an IgA deficiency then the coeliac test will give a false negative
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

How is coeliac disease treated

A

Lifelong gluten-free diet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Name 4 autoimmune conditions associated with coeliac disease

A
  • T1DM
  • Hashimoto’s thyroiditis
  • Primary sclerosing cholangitis
  • Autoimmune hepatitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Give 5 complications of untreated coeliac disease

A
  • Vitamin deficiency
  • Anaemia - Fe, folate, B12
  • Osteoporosis / osteomalacia
  • Lactose intolerance
  • Hyposplenism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is tropical sprue

A

Chronic malabsorption syndrome associated with tropical travel (SEA, Caribbean)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

How does a duodenal biopsy differ in tropical sprue vs coeliac disease

A
  • TS - incomplete villous atrophy
  • CD - complete villous atrophy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Tx for tropical sprue

A

Ab - tetracycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What is gastro-oesophageal reflux disease

A

Reflux of gastric acid from the stomach into the oesophagus due to lower oesophageal sphincter (LOS) relaxing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

6 Risk factors of GORD

A
  • Obesity
  • Pregnancy
  • Hiatus hernias
  • Smoking
  • NSAIDs
  • Male
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What is a hiatus hernia

A

Where part of your stomach moves up into your chest through an opening (hiatus) in the diaphragm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Signs and symptoms of GORD

A
  • Heartburn - worse lying down
  • Acid regurgitation
  • Epigastric/ retrosternal pain
  • Dyspepsia - indigestion
  • Nocturnal cough
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Give 5 red flag symptoms that you might detect when taking a history from someone with dyspepsia

A
  • Anaemia
  • Weight loss
  • Dysphagia
  • Upper abdominal pain
  • Nausea and vomiting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Describe the investigation and diagnosis of GORD

A
  • Endoscopy
  • Manometry - rule out motility disorder and monitor gastric acid pH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Criteria for the 2 week endoscopy referral

A
  • When patient displays red flag signs
  • Over 55 (exc dysphagia = any age )
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Describe the conservative management of GORD

A
  • Lose weight
  • Reduce caffeine and alcohol intake
  • Smoking cessation
  • Smaller, lighter meals
  • Avoid heavy meals 3-4h before bed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Describe the medical treatment of GORD

A
  • Acid neutralising meds - Gaviscon
  • Proton pump inhibitors (PPI) - lansoprazole
  • H2 antagonist - famotidine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

How do proton pump inhibitors work and how should they be taken

A
  • Inhibit gastric secretion by blocking H+/K+ ATPase in parietal cells
  • Best taken on an empty stomach once daily 30 mins before first meal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What is last resort treatment of GORD

A
  • Nissen fundoplication - tying fundus of stomach around lower oesophagus to narrow LOS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

3 complications of GORD

A

Barrett’s oesophagus
oesophagitis
ulcers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What is barret’s oesophagus

A

*Constant acid reflux results in metaplasia of the LOS from a stratified squamous to a simple columnar epithelium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Why is barrett’s considered premalignant

A
  • Associated with increased risk (3-5%) of developing oesophageal adenocarcinoma
  • Metaplasia - dysplasia - adenocarcinoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Diagnosis of Barret’s

A

Biopsy and endoscopy - metaplasia >1cm above gastro-oesophageal junction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Treatment of Barret’s

A

PPI
Endoscopic monitoring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What are the 2 types of peptic ulcer

A
  • Gastric - stomach
  • Duodenal - mc
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Explain the pathophysiology of peptic ulcer disease

A
  • There is a protective layer in the stomach comprised of mucus and bicarbonate secreted by the stomach mucosa
  • Stomach mucosa is prone to ulceration from breakdown of this protective layer and an increase in stomach acid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What causes PUD

A
  • Helicobacter pylori
  • NSAIDs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

State 5 things that can cause increased stomach acid

A
  • Stress
  • Alcohol
  • Caffeine
  • Smoking
  • Spicy food
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

How does PUD present

A
  • Dyspepsia
  • Epigastric pain
  • Haematemesis (vomit blood) and melena
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Which type of ulcer presents with epigastric pain that gets better after eating

A

Duodenal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Which type of ulcer presents with epigastric pain that gets worse after eating

A

Gastric

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Why are duodenal ulcers less painful after eating

A
  • Pyloric sphincter closes during digestion which prevents acid from getting into the duodenum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Investigation of PUD

A
  • Endoscopy and biopsy
  • H.pylori tests
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Treatment of PUD

A
  • Stop NSAIDs
  • H.pylori: Triple therapy = clarithromycin, amoxicillin and PPI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Complication of PUD

A
  • Gastric - ruptured left gastric artery
  • Duodenal - ruptured gastroduodenal artery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Define gastritis

A

Inflammation of the stomach mucosal lining

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

List some causes of gastritis

A
  • H.pylori
  • autoimmune gastritis - related to pernicious anaemia and anti-IF Abs
  • NSAIDs - COX inhibitor
  • Stress
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What does a COX inhibitor do

A

Inhibits cyclooxygenase which inhibits prostaglandin synthesis = less mucous secretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Signs and symptoms of gastritis

A
  • Dyspepsia
  • Epigastric pain
  • Diarrhoea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Describe the investigation and diagnosis of gastritis

A

*GS: Endoscopy & biopsy - inflammation and atrophy
H.pylori:
* stool antigen, urea breath test and rapid urease test during endoscopy
* Stop PPI for at least 2w before testing/ 4w for Ab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Treatment of gastritis

A
  • H.pylori eradication - triply therapy
  • Autoimmune - IM vitamin B12
  • Stop NSAID, alcohol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

State 3 complications of gastritis

A
  • Peptic ulcers
  • Bleeding and anaemia
  • Gastric cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

What is appendicitis

A

Inflammation of the appendix
Surgical emergency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

At what age range is the peak incidence of appendicitis

A

10-20 years old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Where is the appendix located

A

McBurney’s point - 2/3 from umbilicus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Causes of appendicitis

A
  • Faecolith - stony mass of compacted faeces
  • Lymphoid hyperplasia
  • Intestinal worms
90
Q

Explain the pathophysiology of appendicitis

A
  • Obstruction in the lumen of the appendix = stasis = bacterial overgrowth = inflammation
91
Q

Signs and symptoms of appendicitis

A
  • Abdo pain starting at umbilical region and migrating to right iliac fossa
  • Fever
  • Anorexia
92
Q

Signs of appendicitis on physical examination

A
  • Abdo guarding
  • Rovising’s sign - palpitation on LIF causes pain in RIF
  • Rebound tenderness
  • Psoas and obturator sign
93
Q

Investigation and diagnosis of appendicitis

A
  • CT
  • Ultrasound - used in children and in female patients to exclude ovarian and gynaecological pathology
  • Pregnancy test
  • Clinical diagnosis
94
Q

Differential diagnosis of appendicitis

A
  • Ectopic pregnancy
  • Ruptured ovarian cyst
  • Meckel’s diverticulum
95
Q

How is appendicitis treated

A

Appendectomy
* laparoscopic = fewer risks and faster recovery compared to open surgery

96
Q

Define diverticulum

A

Outpouching of the colon mucosa
Pl= diverticula

97
Q

Define diverticulosis

A

Presence of diverticula without any symptoms

98
Q

Define diverticular disease

A

Presence of diverticula with symptoms

99
Q

Define diverticulitis

A

Inflammation and infection of diverticula

100
Q

Describe the pathophysiology of diverticulitis

A

High pressures in colon/ weak wall -> Diverticula -> faeces can get trapped here and obstruct the diverticula -> abscess and inflammation -> diverticulitis

101
Q

Give 3 RFs of diverticular disease

A
  • Older people (>50)
  • Low fibre diet
  • Use of NSAIDs
  • Obesity (BMI >30)
102
Q

What part of the bowel is most likely to be affected by diverticulitis

A

Sigmoid colon

103
Q

Symptoms of diverticular disease

A
  • Left iliac fossa pain
  • Constipation
  • abdo bloating
  • Rectal bleeding
104
Q

Symptoms of diverticulitis

A

• Same as diverticular disease: Bloating, constipation, LLQ pain + guarding,
• ++ fever and diarrhoea

105
Q

Describe the investigation and diagnosis of diverticular disease

A
  • GS: Contrast CT scan
  • Colonoscopy
  • raised CRP
  • FBC - leukocytosis
106
Q

Treatment for diverticulosis

A

Tx not necessary
Dietary and lifestyle changes
• gradually increasing fibre
• weight loss
• Smoking cessation
• Exercise

107
Q

Treatment for diverticular disease

A
  • Bulk-forming laxatives (e.g. ispaghula husk)
  • Paracetamol for abdo pain
  • Dietary and lifestyle changes
108
Q

Treatment for diverticulitis

A
  • Oral co-amoxiclav
  • analgesia - paracetamol
  • Low residue diet - low in fibre and undigested material
  • Severe: IV fluids, Ab and surgery
109
Q

Give 4 complications of diverticulitis

A
  • Peritonitis
  • Perforation
  • Haemorrhage
  • Obstruction
110
Q

Describe H.pylori

A

Gram-negative spiral bacteria

111
Q

Describe the pathology of h.pylori

A
  • Decreases somatostatin
  • Increases luminal gastric acid
  • Produces ammonia
  • Decreased bicarbonate secretion
112
Q

What can H.pylori infection cause

A
  • Gastritis
  • PUD
113
Q

What is Zenker’s diverticulum

A

Outpouching into the pharynx causing food to become stuck there instead of going fully down the oesophagus

114
Q

Signs and symptoms of zenker’s diverticulum

A
  • Smelly breath
  • Regurgitation
115
Q

What type of bacteria is H.pylori

A

Gram-negative spiral bacteria

116
Q

What are the symptoms of an upper GI bleed

A
  • Melena
  • Haematemesis
  • Coffee ground vomit
117
Q

Causes of an upper Gi bleed

A
  • Oesophageal varices
  • Mallory-Weiss tear
  • PUD
118
Q

What is a Mallory Weiss tear

A

Tear in lower oesophagus due to sudden increase in intra-abdominal pressure

119
Q

RFs of MW tear

A
  • Weight lifting
  • Chronic cough
  • Bulimia
  • Food poisoning
  • Heavy Alcohol use
120
Q

Who is a MW tear usually seen in

A
  • Age 20-50
  • Male
121
Q

Signs and symptoms of MW tear

A
  • Haematemesis
  • Melena
  • Hypotension (if severe)
  • Dizziness
122
Q

Investigation of a MW tear

A
  • Upper GI endoscopy - tear/laceration
  • FBC, LFT, U+E
123
Q

Treatment for MW tear

A
  • Most spontaneously heal within 24h
  • Lifestyle: reduce alcohol, CBT for bulimia
124
Q

What is oesophageal varices

A

Enlarged/ dilated collateral veins in the lining of the oesophagus (submucosa)

125
Q

Causes of oesophageal varices

A
  • Cirrhosis of liver
  • HTN in portal venous system
126
Q

Signs and symptoms of oesophageal varices

A
  • Haematemesis and melena
  • Abdo pain
  • Sx of LD: ascites, jaundice, encephalopathy
  • hypotension
  • pallor
127
Q

4 investigations of oesophageal varices

A
  • Gastroscopy - dilated veins in lower oesophagus
  • FBC - microcytic anaemia
  • Elevated urea and creatinine
128
Q

When are oesophageal varices considered an emergency

A

when the vein ruptures this causes large amounts of bleeding

129
Q

Treatment for oesophageal varices with an acute bleed

A
  • ABCDE and IV fluids
  • Terlipressin or somatostatin analogue (octreotide) if CI
  • Vit K for bleeding abnormality
  • Surgery: endoscopic variceal band ligation within 24h
130
Q

Treatment for oesophageal varices without a bleed

A
  • Non-selective beta blocker (propanolol)
  • Annual endoscopy
  • Surgery
131
Q

What is bowel obstruction

A

Mechanical interruption of passage through the bowel

132
Q

What type of bowel obstruction is most common

A

Small bowel obstruction (60-75%)

133
Q

Give 4 causes of small bowel obstruction (SBO)

A
  • Adhesions ( 75% & often surgical)
  • Crohn’s
  • Hernias
  • Malignancy
134
Q

What are the signs and symptoms of SBO

A
  • Vomiting (may contain faeces) first then constipation
  • abdo distension and pain
  • Tinkling bowel sounds
  • Tachycardia and hypotension
135
Q

Give 4 causes of large bowel obstruction (LBO)

A
  • Malignancy (90%)
  • Sigmoid volvulus (twists around itself- coffee bean appearance)
  • Diverticulitis
  • Intussusception (more common in children) is when the bowel fold within itself
136
Q

Signs and symptoms of LBO

A
  • Constipation first then vomiting
  • Intermittent abdo pain
  • Severe distension (RLQ)
137
Q

Describe the investigation of bowel obstruction

A

Abdo XRay:
* dilated bowel loops
* SBO: >3CM & coiled spring appearance
* LBO: >6CM & coffee bean sign if sigmoid volvulus
GS: CT abdo
* FBC - leukocytosis and neutrophilia
* Raised CRP

138
Q

Describe the treatment of bowel obstruction

A
  • IV cannula - fluid resuscitation
  • Nasogastric tube to decompress stomach (Nil by mouth)
  • Analgesia and Antiemetics (N+V) - Metoclopramide
  • Surgery as last resort
139
Q

What is pseudo-obstruction

A

Colonic dilation with no mechanical obstruction

140
Q

Causes of pseudo-obstruction

A

Post-operative (paralytic ileus )
* Meds - opioids, CCB
* Recent trauma/ surgery

141
Q

Treatment for pseudo-obstruction

A

IV neostigmine

142
Q

What is diarrhoea

A

Abnormal passage of 3+ watery stools daily

143
Q

Give 3 types of diarrhoea

A
  • Watery
  • Inflammatory
  • Dysentery - bloody
144
Q

Causes of diarrhoea

A
  • Most commonly viral
  • Non-infective : Coeliac, hyperthyroid, IBD
  • Bacterial infection
  • Ab
  • Parasitic infection
145
Q

What is the leading cause of diarrhoea in children (<3)

A

Rotavirus

146
Q

Which virus is the mc cause of diarrhoea in adults

A

Norovirus - winter vomiting

147
Q

Where is norovirus commonly spread

A

Cruise ships
Hospitals
Restaurants

148
Q

Give 4 bacteria which commonly cause diarrhoea

A
  • Campylobacter jejuni - mc bacterial cause
  • E.coli
  • Salmonella
  • Shigella
149
Q

How can antibiotics cause diarrhoea

A

Ab can interfere with bacteria balance in the bowel
* Can cause clostridium difficile bacteria to multiply and produce toxins = diarrhoea

150
Q

Name 4 Abx that increase risk of C. difficile infection

A
  • Co-amoxiclav
  • Ciprofloxacin
  • Cephalosporins
  • Clindamycin
151
Q

What is the most common parasitic cause of diarrhoea

A

Giardia lamblia

152
Q

Signs and symptoms of diarrhoea

A

Dependant on cause
* Bloody stool - hints bacterial
* Viral cause - fever, fatigue, headache etc
* Non-infective - longer Hx

153
Q

How is diarrhoea diagnosed

A
  • Stool culture
  • PCR - virus and bacteria
  • Increased ESR/CRP = infection
  • Increased eosinophils = parasite
  • High ESR/CRP + anaemia = IBD
154
Q

Treatment for diarrhoea

A

Dependent on cause
* Oral rehydration
* Viral: self-limiting
Meds for symptoms
* Antimotility - loperamide
* Antiemetics

155
Q

What are the 2 types of oesophageal cancer

A
  • Adenocarcinoma
  • Squamous cell carcinoma
156
Q

Which oesophageal cancer is found in the lower 1/3 of the oesophagus

A

Adenocarcinoma

157
Q

Where in the oesophagus are squamous cell carcinomas found

A

Upper 2/3 of oesophagus

158
Q

RFs of adenocarcinoma of the oesophagus

A
  • Barrett’s oesophagus
  • GORD
  • Hernias
  • Caucasian
159
Q

RFs of SSC of the oesophagus

A
  • Smoking
  • Alcohol
  • BAME
160
Q

Signs and symptoms of oesophageal cancer

A
  • Progressive dysphagia ( solids-liquids)
  • Anaemia
  • Weight loss
  • Anorexia
  • Hoarse voice
  • RED FLAGS: ALARMS
161
Q

What would be the likely diagnosis of non-progressive dysphagia

A

Achalasia

162
Q

Describe the investigation of oesophageal cancer

A
  • Upper GI endoscopy and biopsy
  • CT/MRI for tumour staging
163
Q

Treatment of oesophageal cancer

A
  • Surgery with adjuvant chemo/radiotherapy
  • Palliative care
164
Q

Describe the histological differences between type 1 & type 2 gastric cancers

A

Type 1:
* well differentiated
* tubular
Type 2
* Poorly differentiated
* Signet ring cells

165
Q

Which type of gastric cancer has a worse prognosis and why

A

Type 2 has a worse prognosis as it is highly metastatic and has rapid progression

166
Q

RFs of gastric cancer

A
  • Age 50-70
  • Male
  • H.pylori infection
  • Pernicious anaemia
  • Smoking
  • FHx
167
Q

Signs and symptoms of gastric cancer

A
  • Severe epigastric pain
  • Weight loss
  • Progressive dysphagia
  • N+V
168
Q

Describe the investigation of gastric cancer

A
  • Gastroscopy and biopsy
  • CT/MRI for staging
169
Q

Treatment for gastric cancer

A
  • Surgery and chemo/radio
  • Palliative care
170
Q

How common are small bowel cancers

A

Very rare

171
Q

What are bowel polyps

A

small growths on the inner lining of colon or rectum

172
Q

What are the 2 inherited conditions that greatly increase risk of colorectal cancer

A

Familial adenomatous polyposis
* Auto dom AP coli gene mutation = many duodenal polyps
* 93% risk of colorectal cancer
Hereditary nonpolyposis colorectal cancer (lynch syndrome)
* Auto dom mutation
* Rapidly increases progression of adenoma to adenocarcinoma

173
Q

RFs of colorectal cancer

A
  • Alcohol/ smoking
  • Genetic predisposition - FAP and lynch
  • Increasing age
  • IBD
  • obesity
174
Q

Presentation of colorectal cancer

A
  • Blood and mucous in stool
  • Rectal bleeding and mass
  • Weight loss
  • Change in bowel habit
  • Anaemia
  • abdo pain
175
Q

Describe the referral for suspected bowel cancer

A

2 week referral if:
* Over 40 with abdo pain and unexplained weight loss
* Over 50 with unexplained rectal bleeding
* Over 60 with change in bowel habit or Fe deficiency anaemia

176
Q

Describe the investigation of colorectal cancer

A
  • GS: Colonoscopy and biopsy - ulcerating lesions
  • FIT (faecal immunochemical) and faecal occult blood
  • CT chest, abdo and pelvis - colonic wall thickening, enlarged lymph nodes
  • double-contrast barium enema - characteristic “apple core” lesion
177
Q

How is bowel cancer screened

A
  • Age 60-74
  • Every 2 years
  • FIT
178
Q

Where is bowel cancer most common

A

Distal colon (sigmoid and rectum)

179
Q

Treatment for colorectal cancer

A
  • Surgery - incision or resection
  • Chemo - fluorouracil/folinic acid with oxaliplatin
180
Q

What is achalasia

A
  • Rare idiopathic swallowing disorder of the oesophagus resulting in impaired peristalsis
  • LOS fails to relax
181
Q

Signs and symptoms of dysphagia

A
  • Non-progressive dysphagia (both liquids and solids)
  • Substernal heart burn
  • Food regurgitation > aspiration pneumonia
182
Q

Describe the investigation of achalasia

A
  • Barium swallow = beard beak LOS
  • GS: manometry
    Loss of peristalsis
    Increased lower sphincter tone
    Inadequate relaxation of lower sphincter
  • Endoscopy
183
Q

Describe the treatment of achalasia

A
  • Surgery: cardiomyotomy
  • Botox (botulinum toxin) - relax LOS
  • Meds: nitrates/ nifedipine can help relax LOS
  • Balloon dilatation
184
Q

What is a complication of cardiomyotomy

A

Could lead to GORD

185
Q

What is ischaemic colitis

A
  • Ischaemia of colonic arterial supply
  • Colon inflammation due to hypoperfusion
186
Q

What are the mc sites affected by ischaemic colitis

A
  1. Splenic flexure
  2. Sigmoid colon + cecum
187
Q

Signs and symptoms of ischaemic colitis

A
  • LLQ pain
  • Bright bloody stool
  • Hypovolemic shock - pallor, weak rapid pulse
188
Q

Causes of ischaemic colitis

A
  • Atrial fibrillation
  • Thrombosis (mc)
  • Emboli
189
Q

Describe the investigation of ischaemic colitis

A
  • GS: Colonoscopy and biopsy
  • contrast CT angiography - bowel dilation
  • abdo X-RAY - thumbprinting
190
Q

Describe the treatment of ischaemic colitis

A
  • Symptomatic - IV fluid and Ab
  • Infarcted colon - surgery
191
Q

What is mesenteric ischaemia

A

Decreased/ blocked flow to small intestines
* Can be acute or chronic

192
Q

Causes of mesenteric ischaemia

A
  • Thrombosis
  • AF
  • Hernia
193
Q

Signs and symptoms of mesenteric ischaemia

A
  • Severe central colicky abdo pain
  • Rapid hypovolemic shock
  • Abdo bruit (swishing sound)
  • N+V
194
Q

Describe the diagnosis of mesenteric ischaemia

A
  • CT angiography - bowel wall thickening, occlusion
  • FBC and ABG = persistent metabolic acidosis, leukocytosis
195
Q

Treatment for mesenteric ischaemia

A
  • Ab - ceftriaxone and metronidazole
  • IV fluids
  • IV heparin
  • Surgery
196
Q

What type of bacteria is C.difficile

A

Gram positive spore forming bacteria

197
Q

What is pseudomembranous colitis

A

Inflammation of the colon due to overgrowth of clostridium difficile and a recent history of Ab use

198
Q

Explain the pathophysiology of C.diff infection

A
  • C.diff often live harmlessly as normal gut flora keep it under control
  • Certain Ab interfere with this balance by killing normal gut flora
  • C.diff no longer under control
199
Q

Signs and symptoms of pseudomembranous colitis

A
  • Watery diarrhoea
  • Severe dehydration
200
Q

Describe the investigation of pseudomembranous colitis

A
  • Blood test = leucocytosis
  • Stool sample
  • abdo XRay/ CT = colonic dilatation
201
Q

Describe the treatment of pseudomembranous colitis

A
  • Stop causative Ab
  • Give Vancomycin
  • Hydration and electrolyte replacement
  • Infection control - hand hygiene
202
Q

Define haemorrhoids (piles)

A

Swollen veins found inside or around anus that disrupt anal cushions

203
Q

Causes of piles

A
  • Constipation with a lot of straining
  • Anal sex
  • Heavy lifting
  • Pregnacy
204
Q

Describe internal piles

A
  • Originate above dentate line
  • Less painful as it has a much lower sensory supply
  • May feel incomplete emptying
  • They can prolapse
  • covered in mucus
205
Q

Describe external piles

A
  • Originate below dentate line - anal opening
  • covered with skin
  • So painful patients can’t sit down
206
Q

Signs and symptoms of piles

A
  • Bright red bleeding on wiping
  • Itching
  • Lump around/ inside anus
207
Q

Describe the investigation of piles

A
  • Digital rectal exam for external
  • Proctoscopy for internal
208
Q

Describe the treatment of piles

A
  • Conservative: stool softener, high fibre, increased fluids
  • Surgical: Rubber band ligation , Haemorrhoidectomy
209
Q

What is an anal fistula

A

Abnormal open connection between anal canal and the skin near the anus

210
Q

Causes of an anal fistula

A
  • Perianal abscess (70%)
  • Chron’s ulcerations
211
Q

Describe the signs and symptoms of an anal fistula

A
  • Blood and mucous in stool
  • Pruritus ani
  • Throbbing pain
212
Q

Treatment of an anal fistula

A
  • Surgical removal and drainage
  • Ab if infected
213
Q

What is an anal fissure

A

Tear in anal canal below the dentate line

214
Q

Causes of an anal fissure

A
  • Constipation
  • Anal trauma (childbirth)
  • Chron’s/UC (rare)
215
Q

Signs and symptoms of an anal fissure

A
  • Extreme defecation pain
  • Anal bleeding
  • Pruritus ani
216
Q

How is an anal fissure treated

A
  • More fibre and fluids
  • Topical creams
217
Q

What is a perianal abscess

A

Pus filled lump near anus

218
Q

Causes of perianal abscess

A
  • Anal fistula
  • Anal trauma
219
Q

Signs and symptoms of a perianal abscess

A
  • Pus in stool
  • Perianal pain and swelling
220
Q

Treatment for a perianal abscess

A

Surgery and drainage

221
Q

What is a pilonidal sinus/abscess

A

Ingrown hair in the natal crack which form sinuses and gets infected (abscesses)

222
Q

Treatment for pilonidal sinus/abscess

A
  • Hygiene advice
  • Abx

2a - SBCS (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions