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medicine finals > GI > Flashcards

GI Flashcards

1
Q

Which parts of the GI tract are affected by crohns?

A

Anywhere from mouth to anus

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2
Q

Transmural inflammation occurs in which bowel condition?

A

Crohn’s

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3
Q

Which findings on investigation would indicate a diagnosis of crohn’s disease? (4)

A
  1. raised inflammatory markers
  2. increased faecal calprotectin
  3. anaemia
  4. low vit B12 and vit D
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4
Q

Which extra-intestinal features are associated with crohn’s disease ?

A
  1. arthritis
  2. episcleritis
  3. erythema nodosum
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5
Q

What is the differnece between the pattern of disease in UC and Crohn’s?

A

UC - continuous disease from rectum to ileocecal valve
Crohn’s - skip lesions from mouth to anus

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6
Q

What is the management for Crohn’s disease?

A
  1. Start monotherapy with prednisolone to induce remission at first presentation
  2. If there are multiple inflammatory exacerbations in 12 months then add azathioprine
  3. For severe active crohn’s disease - add infliximab
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7
Q

Give 4 symptoms of UC

A
  1. bloody diarrhoea
  2. tenesmus
  3. left iliac fossa pain
  4. extra-intestinal features
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8
Q

Which area of the GI tract is typically most affected in Crohn’s disease?

A

Terminal ileum

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9
Q

What is the management of UC to induce remission?

A
  1. First line = topical aminosalicylate e.g. mesalazine
  2. Second line = oral aminosalicylate
  3. topical/oral corticosteroids e.g. prednisolone
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10
Q

What would you find of biopsy of someone with UC?(4)

A
  1. red, raw, friable mucosa
  2. no inflammation beyond submucosa
  3. crypt abscesses
  4. depletion of goblin cells
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11
Q

What findings would you expect to see on an abdominal X ray of someone with UC?

A

lead pipe appearance of colon

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12
Q

Which extra-intestinal features are most commonly associated with UC? (3)

A
  1. arthritis
  2. primary sclerosing cholangitis
  3. uveitis
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13
Q

How would you treat a symptomatic perianal fistula in crohn’s disease?

A

metronidazole

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14
Q

What is the grading criteria for UC severity?

A

Truelove and Witts Criteria

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15
Q

Which symptoms would be graded as ‘severe UC’? (6)

A
  1. > 6 bowel movements/day
  2. blood in stool
  3. pyrexia
  4. pulse > 90 bpm
  5. anaemia
  6. ESR > 30
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16
Q

When would you admit someone with UC?

A
  1. severe colitis
  2. moderate disease that doesn’t respond to steroid treatment within 2 weeks
17
Q

How would you treat an acute severe flare of UC?

A
  1. IV corticosteroids
  2. IV ciclosporin/surgery
18
Q

What is a complication of UC that needs to be monitored for?

A

colorectal malignancy

19
Q

What is diverticulosis?

A

Very common condition causing outpouching of bowel wall, no symptoms

20
Q

What are risk factors for diverticular disease? (2)

A
  1. increasing age
  2. low-fibre diet
21
Q

What are symptoms of diverticular disease? (2)

A
  1. altered bowel habit
  2. colicky left sided abdo pain
22
Q

What are the symptoms of diverticulitis? (4)

A
  1. constant LIF pain and tenderness
  2. anorexia, N&V
  3. diarrhoea
  4. features of infection
23
Q

How is diverticulitis managed?

A

Systemically unwell = oral co-amoxiclav

Features of complicated acute diverticulitis = NBM, IV fluids, IV AbX

24
Q

What are 4 possible complications of acute diverticulitis?

A
  1. abscess formation
  2. peritonitis
  3. obstruction
  4. perforation
25
Q

How do gastric ulcers present?

A

Epigastric discomfort or pain
Nausea and vomiting
Dyspepsia
Haematemesis/IDA

26
Q

What are the 2 most common causes of peptic ulcer disease?

A

NSAIDs
Helicobacter Pylori infection

27
Q

How would you manage someone with suspected peptic ulcer disease?

A
  1. Review and stop NSAIDs/aspirin/bisphosphonates/steroids/SSRIs
  2. Test for H Pylori infection
    - negative + no NSAIDs = PPI 4-8wks
    - negative + NSAIDs = PPI 8 wks
    - positive + no NSAIDs = H Pylori eradication
28
Q

What does H Pylori eradication involve?

A

PPI + 2 antibiotics
e.g. lansoprazole + amoxicillin + clarithromycin

29
Q

How and when do you test for H Pylori?

A

How:
- Urea (13C) breath test
- Stool helicobacter antigen test

When:
- if dyspepsia symptoms have not improved after a month of PPI
- unexplained IDA after malignancy ruled out
- 6-8 weeks post treatment if no improvement

30
Q

How is Barrett’s oesophagus managed?

A
  1. High dose PPI
  2. Metaplasia = endoscopic biopsies every 3-5 years
  3. Dysplasia = endoscopic ablation
31
Q

How would you manage a patient with endoscopy confirmed GORD?

A

PPI 4-8 weeks
- 2nd line = H2 receptor antagonist (ranitidine)

32
Q

Which drugs may exacerbate the symptoms of GORD?

A
  • alpha-blockers
  • anticholinergics
  • benzodiazepines
  • beta-blockers
  • bisphosphonates
  • calcium-channel blockers
  • corticosteroids
  • NSAIDs
  • nitrates
  • theophyllines
  • tricyclic antidepressants
33
Q

What are possible complications of GORD?

A

oesophagitis
ulcers
anaemia
benign strictures
Barrett’s oesophagus
oesophageal carcinoma

medicine finals (19 decks)

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