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Phase 2a med mine > GI > Flashcards

GI Flashcards

1
Q

What is IBS?

A

‘Functional’ chronic bowel disorder
>3 months GI symptoms with no underlying cause-everything else ruled out

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2
Q

Name some IBS triggers

A

Related to psychology:
Stress
Anxiety
Drugs
Poor diet

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3
Q

Describe the symptoms of IBS

A

Abdominal pain and bloating, relieved from defacation
Altered stool form/frequency

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4
Q

How is IBS diagnosed?

A

Exclusion diagnosis
Serology(coeliac)
Fecal calprotectin(IBD)
ESR, CRP, cultures(infections)

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5
Q

Describe the treatment for IBS

A

Conservative: patient education and reassurance, e.g. more fibre
Moderate:
IBS-C-laxatives(senna)
IBS-D antimotility drug(loperimide)
Severe: TCA(amitriptyline)+consider referral

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6
Q

What are the 3 types of IBS

A

IBS-C: mostly constipation
IBS-D: mostly diarrhea
IBS-M: alternating/mixed C/D

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7
Q

What is GORD?

A

Gastric reflux due into oesophagus due to decreased pressure across the lower oesophageal sphincter->oesophagitis

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8
Q

Name some causes of GORD

A

Increased intraabdominal pressure: pregnancy, obesity
Hiatal hernia: LOS sliders up through oesophagus-mostly sliding type
Drugs like anti muscarinincs
Scleroderma: scarring of LOS

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9
Q

Describe the pathophysiology of GORD

A

Decreased LOS pressure->more potential for passage of acid upwards

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10
Q

Describe the symptoms of GORD

A

Heartburn-retrosternal burning chest pain
Chronic cough
Nocturnal asthma
Dysphagia
Symptoms worse at night

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11
Q

What are the red flag symptoms of GORD

A

Dysphagia
Haematemesis
Weight loss

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12
Q

Describe the diagnosis of GORD

A

If no red flag symptoms:
Clinical diagnosis-straight to treatment
If red flag symptoms:
Endoscopy: oesophagitis/Barret’s oesophagus
Oesophageal manometry: Measure LOS pressure and monitor gastric pH

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13
Q

Describe the treatment of GORD

A

Conservative: lifestyle changes(smaller meals, not just before bed)
Pharmacological: PPI’s or H2RA if CI
Antacids-SE: diarrhoea
Alginates-gaviscon
Surgical: Surgical tightening of LOS

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14
Q

Describe the surgical treatment of GORD

A

Tightening of LOS
Nissen fundoplication: wrap fundus around LOS externally to increase pressure across it

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15
Q

Name 2 complications of GORD

A

Oesophageal strictures
Barrets oesophagus

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16
Q

Describe the presentation and treatment of oesophageal strictures

A

Usually 60+ patients with progressively worsening dysphagia
Treatment: endoscopic oesophageal dilation and PPI

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17
Q

What percentage of GORD patients develop Barrets?

A

10%

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18
Q

Which hernia is always involved with Barrets oesophagus?

A

Hiatal hernia

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19
Q

What is Barrets oesophagus?

A

Metaplasia
Stratified squamous epithelium->simple columnar

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20
Q

What does Barrets increase the risk of?

A

Adenocarcinoma

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21
Q

Describe the typical presentation of a patient with Barrets oesophagus

A

Middle-aged caucasian male with a history of GORD and progressively worsening dysphagia

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22
Q

Describe the progression of normal esophagus to adenocarcinoma

A

Normal->metaplasia(Barret’s)->dysplasia(adenocarcinoma)

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23
Q

How is Barret’s diagnosed?

A

Biopsy

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24
Q

What is a Mallory Weiss tear?

A

Linear lower oesophageal mucosal tear due to sudden increase in intra-abdominal pressure

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25
Q

Describe the typical presentation of someone with a Mallory Weiss tear

A

Young male with acute history of retching (e.g. after night out) that eventually causes haematemesis

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26
Q

Name some risk factors for developing a Mallory Weiss tear?

A

Alcohol
Chronic cough
Bullemia
Hyperemesis gravidarum
No history of liver disease and pulmonary hypertension

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27
Q

What is hyperemesis gravidarum?

A

Pregnancy complication: severe nausea and vomiting-> weight loss, dehydration

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28
Q

What is a differential diagnosis for Mallory Weiss tear and how can you distinguish between them?

A

Haematemesis + portal hypertension/liver disease->Oesophageal varices rupture
Haematemesis + no liver history + retching history-> Mallory Weiss tear

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29
Q

Describe the symptoms of a Mallory Weiss tear

A

Haematemesis (after retching/vomiting history)
Hypotension if severe

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30
Q

What scoring system is used to assess the severity of upper GI bleeds?

A

Rockall score

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31
Q

How would you diagnose a Mallory Weiss tear?

A

OGD (endoscopy)

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32
Q

How is a Mallory Weiss tear treated?

A

Most heal spontaneously within 24 hours

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33
Q

What is peptic ulcer disease?

A

Punched out holes in either stomach or duodenum

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34
Q

What are the 2 types of PUD and which is more common?

A

Gastric-less common
Dudoenal-most common

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35
Q

Where are gastric ulcers found?

A

Most in lesser curve of the stomach

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36
Q

Name some causes of gastric ulcers

A

H. Pylori
NSAID’s
Zollinger Ellison syndrome

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37
Q

What is Zollinger-Ellison syndrome?

A

Triad of:
-Pancreatic tumor
-Gastric acid hypersecretion
-Widespread peptic ulcers

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38
Q

Describe the symptoms of gastric ulcers.

A

Epigastric pain
-Worse on eating
-Better between meals and with antacids
-Typically weight loss

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39
Q

Name some red flags for PUD

A

> 55
Haematemesis/melaena
Anaemia
Dysphagia

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40
Q

Describe the diagnosis of gastric ulcers

A

If no red flags:
-C-urea breath test and stool antigen test
If red flags:
-Urgent endoscopy and biopsy

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41
Q

Where are duodenal ulcers mostly found?

A

D1/D2 posterior wall

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42
Q

Name some causes of duodenal ulcers

A

H. Pylori-MOST COMMON
NSAID’s
Zollinger Ellison syndrome

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43
Q

Describe the symptoms of duodenal ulcers

A

Epigastric pain
-Worse between meals
-Better with food
-Typically weight gain

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44
Q

Describe the diagnosis of duodenal ulcers

A

If no red flags:
-Urea breath test
-Stool antigen test
If red flags:
Urgent endoscopy + biopsy

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45
Q

What would you expect to see on the biopsy if the patient has a duodenal ulcer

A

Brunner’s gland hypertrophy->more mucus production

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46
Q

What is important to check to avoid false negatives when testing for H.pylori

A

If testing for H.Pylori, patient must be off PPI’s for >2 weeks

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47
Q

Describe the treatment for PUD

A

Stop NSAID’s
If H.pylori->triple therapy: CAP-clarithromycin, amoxicillin and PPI
If PU found, rescope 6-8 weeks later

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48
Q

Name a complication of peptic ulcers

A

Bleeding from ruptured left gastric artery
Less common

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49
Q

Name a complication of duodenal ulcers

A

Bleeding from ruptured gastroduodenal artery
Very common

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50
Q

Name the 9 regions of the abdomen

A

Right hypochondriac-epigastric region-left hypochondriac
Right lumbar-umbilical region-left lumbar
Right iliac-hypogastric region-left iliac

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51
Q

What are the 2 main signs of an upper GI bleed?

A

Haematemesis(vomiting fresh blood)
Melena (‘digested’ blood-black stools)

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52
Q

What is the main sign of a lower GI bleed?

A

Haematochezia (fresh red blood in stools)

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53
Q

What are the red flag GI signs?

A

ALARMS
Anaemia
Loss of weight
Anorexia (loss of appetite)
Recent onset of progressive symptoms
Masses/melena or bleeding form any part of GI tract
Swallowing difficulties

+>55 years

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54
Q

Which conditions are associated with haematemesis?

A

Mallory Weiss
Oesophageal varices
Oesophageal cancer

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55
Q

Which GI conditions are associated with dysphagia?

A

Achalasia
Oesophageal cancer
Zenker’s diverticulum
Systemic sclerosis
Strictures

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56
Q

Which GI conditions are associated with pain

A

Mallory Weiss
Oesophageal varices
GORD

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57
Q

What are oesophageal varices?

A

Enlarged veins that protrude into the oesophagus

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58
Q

Name the cause of oesophageal varices

A

Hypertension in portal venous system due to liver issues

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59
Q

Name some symptoms of oesophageal varices

A

Rupture and lead to:
-Haematemesis
-Abdominal pain
-Systemic: shock, hypotension, pallor

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60
Q

How are oesophageal varices diagnosed?

A

Endoscopy

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61
Q

Describe the treatment of oesophageal varices during an acute bleed

A

ABCDE
Vasopressin (terlipressin) for vasoconstriction
Bleeding abnormalities: vitamin K
Surgery: endoscopic variceal band ligation within 24 hours

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62
Q

Describe the treatment of oesophageal varices without bleeding

A

Beta-blocker (propanolol)
Endoscopic variceal band ligation

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63
Q

How does H pylori cause ulcers?

A

Secretes urease->urea is converted to ammonium which is toxic to gastric mucosa-> decreased mucus + increased inflammation->increased acid production

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64
Q

How do NSAIDs cause ulcers?

A

Inhibit COX pathway->inhibitin prostaglandin secretion-> decrease in gastric mucosa-> ulcer

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65
Q

What is gastritis?

A

Mucosal inflammation and injury

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66
Q

Name some causes of gastritis

A

Autoimmune
H.pylori
NSAID’s
Mucosal ischemia
Campylobacter

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67
Q

Which autoimmune conditions are associated with gastritis?

A

Pernicious anaemia
Anti IF antibodies

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68
Q

How do NSAID’s cause gastritis?

A

Cause gastropathy: injury without inflammation

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69
Q

Describe the symptoms of gastritis

A

Epigastric pain
Diarrhoea
Nausea and vomiting
Indigestion

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70
Q

How is gastritis diagnosed?

A

If H.pylori suspected:
-Stool antigen test/urea breath test
Gold standard: endoscopy and biopsy

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71
Q

How is gastritis caused by H pylori treated?

A

Triple CAP therapy
Clarithromycin, amoxicillin, PPI

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72
Q

Which part of the stomach does autoimmune gastritis affect and what does this cause?

A

Fundic portion
Causes atrophy of parietal cells

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73
Q

Name a complication of gastritis

A

PUD

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74
Q

Describe the effect of H pylori in the stomach

A

1)Decreases somatostatin
2)Decreases luminal HCO3-
3)Secretes urease-toxic NH3
4)Increases gastrin release

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75
Q

What is appendicitis?

A

Inflammation of the appendix, usually due to lumen obstruction

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76
Q

What age range is appendicitis most commonly found in?

A

10-20

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77
Q

Name the causes of appendicitis

A

Faecolith(hard solid faeces)
Lymphoid hyperplasia
Filarial worms

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78
Q

How does appendicitis become a surgical emergency?

A

Blockage can become infected with E.Coli
Blockage causes an increased pressure inside the appendix->increased rupture risk
Can lead to spontaneous bacterial peritonitis

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79
Q

Describe the symptoms of appendicitis

A

Umbilical pain which localises to McBurneys point
Rebound tenderness
Abdominal guarding
Pyrexia
Rosving’s sign(Press on LLQ causes RLQ pain)
Pain on internal rotation of thigh
Pain when lying on side and extending right leg

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80
Q

Where is McBurneys point?

A

2/3 the distance from the navel to the right anterior superior iliac spine

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81
Q

Name a complicatino of appendicitis

A

SBP, periappendical abscess

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82
Q

How is appendicitis diagnosed?

A

CT abdomen and pelvis

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83
Q

Name a differential diagnosis for appendicitis and how you would rule this out

A

Ectopic pregnancy
Pregnancy test to rule out

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84
Q

Describe the treatment for appendicitis

A

Antibiotics then appendectomy(laparoscopic)
Must drain abscesses

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85
Q

Describe the management of periappendical abscesses

A

Must be drained, then given intra-abscess antibiotics
Resistant to systemic antibiotics as walled off bacterial collection

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86
Q

What is diverticular disease?

A

Outpouching of colonic mucosa

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87
Q

What is the difference between diverticular disease and diverticulosis?

A

Diverticular disease: symptomatic outpouch
Diverticulosis: Asymptomatic outpuch

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88
Q

What is a diverticulum?

A

An outpouching at perforating artery sites

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89
Q

What is diverticulitis?

A

Inflammation of the outpouch: infection

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90
Q

Are most diverticular symptomatic or asymptomatic?

A

95% diverticula-asymptomatic
Only 5%->diverticular disease

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91
Q

What is Meckel’s diverticulum?

A

Paediatric disorder
Failure of obliteration of the vitelline duct

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92
Q

Describe the signs and symptoms of Meckels diverticulum

A

Rule of 2’s:
2 years old
2 inches long
2 ft from ileocaecal valve (umbilical)

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93
Q

How is Meckel’s diverticulum diagnosed?

A

Technetium scan

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94
Q

Name some risk factors for diverticular disease

A

Connective tissue disorders: Marfans, EDS
Ageing
Increased colon pressure: COPD, chronic cough, age

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95
Q

Describe the symptoms of diverticular disease

A

Triad:
-LLQ pain
-Constipation
-Fresh rectal bleeding

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96
Q

How is diverticular disease diagnosed?

A

CT abdomen/pelvis with contrast

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97
Q

Describe the treatment for diverticulosis

A

Nothing: watch and wait

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98
Q

Describe the treatment for diverticular disease

A

Bulk forming laxatives
GS: surgery

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99
Q

Describe the treatment for diverticulitis

A

Antibiotics(co-amoxciclav) + paracetemol
IV fluid + liquid food, rarely surgery

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100
Q

What kind of obstruction is an intestinal obstruction?

A

Mechanical bowel obstruction

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101
Q

Which areas of the bowel can be obstructed?

A

Small bowel: 60-75%
Large bowel: 25-40%

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102
Q

Name some causes of a small bowel obstruction

A

Adhesions: often surgical
Crohn’s
Strangulating hernias
Malignancy

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103
Q

What is the most common cause of small bowel obstructions?

A

Adhesions

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104
Q

Name the symptoms of a small bowel obstruction

A

First vomiting, then constipation
Mild abdominal distention and pain
Tinkling bowel sounds (hyperresonant bowel sounds)

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105
Q

How do you diagnose bowel obstructions?

A

1st line: CXR-dilated bowel loops + transluminal gas shadows
GS: CT abdomen

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106
Q

What CXR findings indicated bowel obstructions?

A

Dilated bowel loops
Transluminal fluid-gas shadows
LBO: Coffee bean sign

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107
Q

Describe the treatment for bowel obstructions

A

Fluid resus
NG tube
Antiemetics and analgesia
Antibiotics: reduce sepsis risk
Surgery as last resort

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108
Q

Name the causes of a large bowel obstruction

A

Malignancy-90%
Volvulus
Intussusception

109
Q

What is the most common cause of LBo’s?

A

Malignancy

110
Q

What is a volvulus?

A

Abnormal twisting of the intestine
Mostly affects sigmoid colon
Found in children

111
Q

What is intussusception?

A

Bowel telescopes in on itself
Most common in children

112
Q

What is pseudo-obstruction?

A

No mechanical obstruction, often a result of post-op state
E.g. opiate induced paralytic ulcers

113
Q

What is Hirschprung’s disease?

A

Congenital malformation: born without a colon nerve supply-can’t poo properly and often leads to LBO

114
Q

What counts as diarrhoea?

A

> 3 watery stools a day:level 5-7 on Bristol stool chart

115
Q

How long does acute diarrhoea last for?

A

<14 days

116
Q

How long does subacute diarrhoea last for?

A

14-28 days

117
Q

How long does chronic diarrhoea last for?

A

> 28 days

118
Q

What are the different types of diarrhoes?

A

-Watery
-Secretory
-Osmotic
-Functional (IBS)
-Steatorrhoea
-Inflammatory

119
Q

What does bloody diarrhoea indicate?

A

Dysentery
E.g. amoebic dysentery
E.Coli/salmonella/shigella

120
Q

Name some non-infective causes of diarrhoea

A

IBD
Coeliac
Hyperthyroidism
Inflammation/malignancy

121
Q

Describe the infective causes of diarrhoea

A

Viral: rotavirus(kids), norovirus(adults)
Bacterial: C.diff, Campylobacter, E.Coli, salmonella, shigella, cholera
Worms
Antibiotics (increases risk of C diff infections)
Giardias + amoeba

122
Q

What is the most common cause of infective diarrhoea?

A

Viral

123
Q

What is the most common cause of bacterial diarrhoea?

A

Campylobacter

124
Q

Which antibiotics increase the risk of C.diff infection and therefore diarrhoea?

A

4C’s
Clarhythromycin
Co-amoxciclav
Ciprofloxacin
Cephalosporin

125
Q

What is the most likely cause of diarrhoea in a child under 3?

A

Rotavirus

126
Q

What is the most likely cause of diarrhoea in a patient on antibiotics?

A

C.diff

127
Q

What is the most likely cause of diarrhoea in a patient with Guillian Barre?

A

Campylobacter

128
Q

What is the main difference in symptoms between infective and non-infective diarrhoea?

A

Infective: acute, often travellers
Non-infective: Longer history

129
Q

Describe the treatmetn of diarrhoea

A

Depends on the cause
Viral-most common-self limiting

130
Q

What complications can arise from diarrhoea?

A

Dehydration and electrolyte loss
Treat with fluids, dioralyte

131
Q

What are the 2 types of oesophageal cancer?

A

Adenocarcinoma
Aquamous cell carcinoma

132
Q

What part of the oesophagus does oesophageal adenocarcinoma affect?

A

Lower 2/3 of oesophagus

133
Q

Name a risk factor for oesophageal adenocarcinoma

A

Barrett’s oesophagus

134
Q

What part of the oesophagus does oesophageal squamous cell carcinoma affect?

A

Upper 2/3 of oesophagus

135
Q

Name some risk factors for developing oesophageal squamous cell carcinoma

A

Smoking
Alcohol

136
Q

Describe the symptoms of oesophageal cancer

A

Presents when advanced:
ALARMS
Anaemia
Loss of weight
Anorexia
Recent sudden symptom worsening
Melenea/haematemesis
Swallowing difficulties-progressive

137
Q

What is the most key symptoms suggestive of oesophageal cancer?

A

Progressive swallowing difficulties

138
Q

Name a differential diagnosis for oesophageal cancer and how you can distinguish between them

A

Achalasia: non progressive swallowing difficulties
Oesophageal cancer: progressive

139
Q

How is oesophageal cancer diagnosed?

A

OGD(gastroscopy) and biopsy (with barium swallow)
CT/PET for staging

140
Q

Describe the treatment for oesophageal cancer

A

Medically fit: chemo/radio and surgery
Unfit: palliative

141
Q

What kind of cancers are most gastric carcinomas?

A

Adenocaricnomas

142
Q

Describe the stageing of gastric carcinomas

A

T1: well differentiated-better prognosis: more common
T2: Undifferentiated-worse prognosis: typically at proximal stomach

143
Q

Name some causes of gastric cancer

A

H.pylori
Smoking
CDH-1 mutation(mutated cadherin gene-80% risk)
fHx
Pernicious anaemia->AI chronic gastritis

144
Q

Describe the symptoms of gastric cancer

A

Severe epigastric pain(like gastritis but worse_
Anaemia (Fe deficiency, weight loss, progressive dysphagia
Mets signs: jaundice->liver mets
Krukenberg tumour->ovarian mets
Lymph nodes: Virchow’s node: supraclavicular
Sister Mary Joseph node: umbilical

145
Q

How is gastric cancer diagnosed?

A

Gastroscopy and biopsy
CT/MRI for staging, PET to ID mets

146
Q

Describe the treatment for gastric cancer

A

Surgery + ‘ECF’ chemo regimen, if resectable

147
Q

How common are SI carcinomas and what kind of carcinomas are they?

A

1% of all GI tumours
SI pretty tumour resistant
Adenocarcinomas

148
Q

Name some RF’s for developing SI carcinoma

A

Chronic SI disease, e.g. Crohn’s, coeliac

149
Q

How is SI carcinoma diagnosed?

A

Gastroscopy and biopsy
CT/MRI for staging, PET for mets

150
Q

How is SI carcinoma treated?

A

Surgery + ‘ECF’ chemo regimen

151
Q

What kind of cancer is colorectal cancer?

A

Adenocarcinoma

152
Q

What is the main precursor for colorectal cancer?

A

Polyps/adenomas: mostly spontaneous and benign, common with age but can progress to cancers

153
Q

Which 2 inherited conditions massively increase the risk of polyps?

A

1)Familial adenomatous polyposis(FAP)
2)Hereditary non polyposis colon cancer (HNPCC-lynch syndrome)

154
Q

What is FAP?

A

Familial adenomatous polyposis
Autosomal dominant APC gene mutation->1000s of duodenal polyps
Inevitably will get colorectal cancer

155
Q

What is HNPCC?

A

Hereditary non polyposis colon cancer/Lynch syndrome
Autosomal dominant MSH-1/2 mutation->DNA mismatch repair gene
Rapidly increases progression from adenoma->adenocarcinoma

156
Q

Name some risk factors for developing colorectal cancer

A

Familial inherited genetic predisposition
Adenomas/polyps
Alcohol, smoking, UC

157
Q

Where does colorectal cancer commonly metastasize to?

A

Liver
Lung

158
Q

Where is colorectal cancer mostly found?

A

Distal colon->sigmoid

159
Q

Describe the symptoms of colorectal cancer

A

LLQ pain
Bloody mucus stools(fresh blood->distal colon, closer to anus)
Tenesmus(if rectal involvement)

160
Q

What is tenesmus?

A

Feeling of needing to pass stools even when bowels are empty

161
Q

How is colorectal cancer diagnosed?

A

FIT test (faecal occult)
Suspected cancer 2 week wait pathway
GS: colonoscopy and biopsy

162
Q

What is a FIT test?

A

Fecal occult
Screening test for micro blood particles in feces.
Done in all >60 patients with iron deficiency anaemia and change in bowel habits

163
Q

When would patients suspected of having colorectal cancer be referred to the 2 week cancer pathway?

A

Positive FIT test and symptoms->referred for colonoscopy/biopsy within 2 weeks

164
Q

How is colorectal cancer staged?

A

TNM system

165
Q

Describe the treatment for colorectal cancer

A

Surgery is only curative option-if no mets
Chemo

166
Q

What is dyspepsia?

A

Presenting symptom of ‘indigestion’

167
Q

Describe the symtpoms of dyspepsia

A

Early satiation
Epigastric pain and reflux
Extreme fullness

168
Q

Describe the causes of dyspepsia

A

Often unknown-‘functional’ disorders
May be related to ulcers, especially gastric

169
Q

What investigations would you do in someone with dyspepsia?

A

Needs endoscopy to find the underlying cause

170
Q

Describe the virulence of H pylori

A

Low virulence
Commensal in GIT

171
Q

Is H pylori gram positive or negative

A

Gram negative

172
Q

How does H pylori cause pathological effects?

A

1)Decreases somatostatin
2)Increases luminal gastric acid (as increases gastrin)
3)Urease->ammonia generation
4)Decreased HCO3- secretion

173
Q

Name some GIT conditions that H pylori can cause

A

PUD
Gastritis
Gastric carcinomas

174
Q

How can H.pylori be diagnosed?

A

Biopsy (stool antigen + C urea breath test often 1st line)

175
Q

How is H pylori treated?

A

Triple therapy:
Clarythromcyin + Amoxcicillin + PPI

176
Q

Is E.Coli gram positive or gram negative?

A

Gram negative

177
Q

Describe the virulence of E.Coli

A

Often commensal
Some strains/serotypes are very virulent

178
Q

Which E.Coli strains cause watery diarrhoea?

A

ETEC
EAEC
EPEC

179
Q

Which E.Coli strains cause blood diarrhoea?

A

EHEC(H-haemorrhage)

180
Q

Which E.Coli serotpye causes haemolytic uremic syndrome?

A

Serotype 0157:H7->haemorrhagic diarrhoea + nephritic syndrome

181
Q

Describe the treatment of E.Coli

A

Often amoxicillin or trimethoprin/nitrofurantoin

182
Q

What conditions does E.Coli commonly cause?

A

UTI’s
Diarrhoea in GIT

183
Q

Is C difficile gram positive or negative?

A

Gram positive spore forming bacteria

184
Q

What can induce C difficile?

A

Antibiotics: 4C’s
Ciprofloxacin
Co-amoxiclav
Cephalosporins
Clindamycin

185
Q

What condition does C difficile cause?

A

Pseudomembranous colitis

186
Q

What is pseudomembranous colitis?

A

Swelling/inflammation of large intestine due to C difficile overgrowth

187
Q

How can antibiotics lead to severe diarrhoea?

A

Normal GIT flora killed by C’s antibiotics and C.diff replaces these
Results in dangerous severe diarrhoea (very watery->high risk of dehydration)

188
Q

What is the treatment for C.difficile?

A

Stop using C’s antibiotics
Give vancomycin

189
Q

What is achalasia?

A

Oesophageal dysmotility(impaired peristalsis)
LOS fails to relax
Rare and idiopathic

190
Q

Describe the symptoms of achalasia

A

Non progressive dysphagia(struggle to swallow everything)
Chesty substernal pain
Food regurgitation
Aspiration pneumonia

191
Q

How is achalasia diagnosed?

A

‘Bird beak’ on barium swallow
Diagnostic: manometry->measure pressure across LOS

192
Q

Describe the treatment of achalasia

A

Only curative: surgery: balloon stenting
Drugs that can help pre-surgery: nifedipine, nitrates

193
Q

What is ischaemic colitis?

A

Ischaemia of colonic arterial supply->colon inflamed due to hypoperfusion

194
Q

Name some causes of ischaemic colitis

A

Affecting IMA:
Thrombosis (with/without atherogenesis)
Emboli
Low CO + arrhythmias e.g. shock
COCP

195
Q

What are the most common sites affected by ischaemic colitis?

A

Watershed areas:
Splenic flexure(most common)
Sigmoid colon + cecum

196
Q

Describe the symptoms of ischaemic colitis

A

LLQ pain + bright bloody stool
With/without signs of hypovolaemic shock

197
Q

How is ischaemic colitis diagnosed?

A

Colonoscopy + Biopsy
Only done after patient fully recovered-prevents stricture formation + normal healing)
Rule out other causes: stool sample->H/pylori

198
Q

Describe the treatment of ischamic colitis

A

Symptomatic: IV fluid and antibiotics (prophylactic)
Gangrenous(infarcted colon)->only surgery

199
Q

Name some complications of ischaemic colitis

A

Perforation->SBP
Strictures->obstruction

200
Q

What is mesenteric ischaemia?

A

Ischaemia of the small intestine

201
Q

What are the 2 types of mesenteric ischaemia?

A

AMI: acute mesenteric ischaemia: acute attack: ‘abdominal MI’
CMI: chronic mesenteric ischaemia: long lasting over months: ‘abdominal angina’

202
Q

Name the causes of mesenteric ischaemia

A

Affecting SMA:
Thrombosis: most common
Emboli: often due to AF

203
Q

Describe the symptoms of mesenteric ischaemia

A

Triad:
Central/right iliac fossa acute severe abdominal pain
No abdominal signs on exam (no guarding/rebound tenderness etc)
Rapid hypovolemic shock

204
Q

How is mesenteric ischaemia diagnosed?

A

CT angiogram
FBC+ABG: persistent metabolic acidosis

205
Q

How is mesenteric ischaemia treated?

A

Fluid resus, antibiotics, IV heparin to decrease thromboemboli risk
Infarcted bowel->surgery

206
Q

Name a complication of mesenteric ichaemia

A

SBP

207
Q

What are haemorrhoids?

A

Swollen veins around anus disrupt anal cushions->part of anal cushions prolapse through tight anal passage

208
Q

Name some causes of haemorrhoids

A

Constipation with increased straining: most common
Anal sex

209
Q

What are the 2 types of haemorrhoids?

A

Internal
External

210
Q

What are internal haemorrhoids?

A

Originate above internal rectal plexus (dentate line)
Less painful as has much lower sensory supply->may feel incomplete emptying

211
Q

What are internal haemorrhoids?

A

Originate below denatate line
So painful patients can’t sit down

212
Q

Describe the symptoms of haemorrhoids

A

Bright red fresh PR bleeding
Mucusy stool
Bulging pain
With/wihtout pruritus ani

213
Q

How are haemorrhoids diagnosed?

A

Digital PR exam for external-may be visible
Internal haemorrhoids->proctoscopy

214
Q

How are haemorrhoids treated?

A

Stool softener
Definitive: rubber band ligation

215
Q

What is a perianal abscess?

A

Walled off collection of stool and bacteria around anus

216
Q

What is the most common cause of a perianal abscess?

A

Anal sex->anal gland infection

217
Q

Describe the symptoms of a perianal abscess

A

Pus in stool and constant pain

218
Q

Describe the treatment for a perianal abscess

A

Surgical removal and drainage
(Antibiotics won’t work-walles off so resistant to oral antibiotic therapy)

219
Q

What is an anal fistula?

A

Abnormal ‘tracks’ form between inside of anus->elsewhere, e.g. subcut skin
Typically progresses from perianal abscesses
Abscess discharges which aids fistual formation as abscess grows

220
Q

Describe the symptoms of an anal fistula

A

Bloody, mucusy discharge, often very visible and painful

221
Q

Describe the treatment for an anal fistula

A

Surgical removal and drainage-with antibiotics if necessary

222
Q

What in an anal fissure?

A

Tear in the anal skin lining below the dentate line

223
Q

Name the causes of an anal fissure

A

Hard faeces: most common
Also trauma, like childbirth
Crohn’s/UC

224
Q

Describe the symptoms of an anal fissure

A

Extreme defacation pain(strong sensory supply)
Very itchy bum: pruritus ani
Anal bleeding

225
Q

Describe the treatment for an anal fissure

A

Stool softening: increase fibre and more fluid
Topical creams like lidocaine ointment
Definitive: surgery(not really used)

226
Q

What is a pilondial sinus?

A

Hair follicles get stuck in natal cleft
Form small tracts->sinuses
Get infected->abscesses

227
Q

Name a risk factor for pilondial sinus/abscess

A

Very hairy

228
Q

Describe the sympotms of a pilondial abscess

A

Swollen pus filled smelly abscess on bumcrack-visible on exam

229
Q

Describe the treatment for a pilondial abscess

A

Surgery
Hygiene advice

230
Q

What is Zenker’s diverticulum also called and what is it?

A

Pharyngeal pouch
Food goes down the pouch instead of totally down oesophagus

231
Q

Describe the symptoms of Zenker’s diverticulum

A

Smelly breath (food accumulates in oesophagus)
Regurgitation and aspiration of food

232
Q

What histological finding is associated with CMV

A

Owl eye colitis

233
Q

How is cytomegalovirus an AIDS defining illness?

A

Causes owl eye colitis in immunosuppressed patients

234
Q

Name 2 causes of pseudomembranous colitis

A

C.difficile
CMV

235
Q

What is coeliac’s disease?

A

Autoimmune T4 hypersensitivity to gluten

236
Q

What are the 2 main coeliac genes?

A

HLADQ2
DQ8

237
Q

Describe the apthophysiology of coeliac disease

A

Prolamins in gluten(alpha gliadin) binds to IgA then interacts with ttG->immunogenic
Results in formation of:
High IgA
IgA anti-ttG
EMA antibodies

238
Q

What does tTG stand for?

A

Tissue transglutaminase

239
Q

What conditions are associated with coeliac disease?

A

Thyroid disorders
Addison’s

240
Q

Describe the symptoms of coeliac disease

A

Malabsorption: Haematinic deficiency->anaemia
Steatorrhoea
Diarrhoea
Osteopenia
Weight loss and failure to thrive
Dermatitis herpetiformis

241
Q

What is dermatitis herpetiformis?

A

Papular rash on knees due to IgA skin deposition

242
Q

How is coeliac diagnosed?

A

Only work if a patient is consistenly eating gluten:
Serology: anti-ttG(most specific)
Increased total IgA-> may get false negative in IgA deficient patients
High EMA
Duodenal biopsy: crypt hyperplasia and villous atrophy(and epithelial lymphocyte infiltration)

243
Q

Describe the treatment for coeliac disease

A

Stop eating gluten
Replace vitamins and mineral deficiency
Monitor osteoporosis with DEXA scans

244
Q

What is tropical sprue?

A

Enteropathy associated with tropical travel
Produces similar biopsy to coeliac

245
Q

What is the treatment for tropical sprue?

A

Often responds to antibiotics like tetracycline

246
Q

Name a Ddx for coeliac disease

A

Tropical sprue

247
Q

What groups are associated with IBD?

A

MC in Jews
Associated with HLAB27(seronegative spondylarthropathy)
Bimodal age: 15-20, 55+

248
Q

Describe the pathophysiology of Crohn’s

A

NOD-2 mutation and enteric bacteria cause immune mediated response(T cells)
-TNF alpha
IL1, IL6

249
Q

Where does Crohn’s disease affect?

A

Whole GIT
Especially termianl ileum and proximal colon-usually spares rectum

250
Q

Name some risk factors for developing Crohn’s

A

fHx
Jewish
Smoking(2 x likely)

251
Q

What kind of inflammation is associated with Crohn’s?

A

Transmural (all 4 layers)

252
Q

Describe the intestinal symptoms of Crohn’s

A

Pain in RLQ
Malabsorption as SI infected
-B12/folate/Fe deficiency
-Gallstones/kideny stones
-Watery diarrhoea

253
Q

Name some extra intestinal symtpoms of Crohn’s

A

Apthous mouth ulcers
Uveitus/Episcleritis
Erythema nodosum/pyoderma gangrenosum
Spondyloarthritis-SPINEACHE

254
Q

How is Crohn’s diagnosed?

A

Negative pANCA, might be be ASCA positive
High faecal calprotectin
Biopsy and endoscopy/XR
Endoscopy: skip lesions, cobblestoning, strictures(string sign)
Biopsy: transmural inflammation with non caseating granulomas

255
Q

Describe the treatment for Crohn’s

A

For flares: sulfasalazine(PR) and orednisolone
For remission: Azathioprine, methotrexate
Biologics: anti TNFa: infliximab, IL12+23 inhibitor: ustekenumab

256
Q

Why isn’t surgery curative for Crohn’s?

A

Entire bowel can be affected: cutting out one part can cause other parts to flare up

257
Q

Name some complicatiions of Crohn’s

A

Fistula
Strictures
Abscesses
Small bowel obstruction

258
Q

Describe the pathophysiology of UC

A

AI colitis, associated with HLAB27 gene and pANCA

259
Q

Where does UC affect?

A

Colon only
Starts at rectum(proctitis)->sigmoid->proximal colon

260
Q

Name some risk factors for developing UC

A

fHx
Jewish
Smoking is protective!

261
Q

Describe the inflammation associated with UC

A

Confined to mucosa

262
Q

Describe the intestinal symptoms of UC

A

Pain in LLQ and tenesmus
Bloody mucusy water diarrhoea

263
Q

Describe the extraintestinal symtpoms of UC

A

Uveitus/episcleritis
Pyodema gangrenosum/erythema nodusum
Spondylarthropathy: SPINEACHE
PSC: 90% UC patients have PSC

264
Q

How is UC diagnosed?

A

pANCA positive
High faecal calprotectin
Colonoscopy: continuous inflammation
CXR: ‘lead pipe sign’
Biopsy: Mucosal inflammation with crypt hyperplasia

265
Q

What scoring system is used to assess UC severity?

A

Truelove and Witts

266
Q

Describe the treatment of UC

A

Flares: sulfasalazine and pred
Remission: azathioprine, methotrexate, ciclosporin
Biologics: anti TNFa: infliximab
Surgery: total/partial colectomy: curative

267
Q

Name a complication of UC

A

Toxic megacolon
Most common complication causing UC death

268
Q

Describe the gastric acid production in the parietal cells

A

H2O+CO2->H2CO30>HCO3-(blood)+H+(C–>HCl

Phase 2a med mine (11 decks)

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