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Phase 2a flashcards (Alec's) > GI > Flashcards

GI Flashcards

1
Q

What gene increases your risk of IBD?

A

HLA-B27 (for all seronegative spondyloarthropathy)

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2
Q

What age is IBD most common?

A

Bimodal:
* 15-20
* 55+

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3
Q

What are some risk factors/ causes of Crohns (4)?

A
  • Family history
  • Smoking
  • NOD-2 mutation
  • Recent bacterial infection
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4
Q

What are some risk factors/ causes for UC (2)?

A
  • Family history
  • Recent bacterial infection
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5
Q

What antibodies can be found in people with UC?

A

pANCA autoantibodies

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6
Q

What is protective against UC?

A

Smoking

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7
Q

Where does Crohns affect?

A

Whole GI tract (especially terminal ileum and proximal colon, often spares rectum)

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8
Q

Which layers of gut wall does Crohns affect?

A

Transmural (all layers)

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9
Q

What does the body fail to absorb in Crohns?

A

Pretty much anything especially B12, folate (B9), Fe, H2O

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10
Q

Where does UC affect?

A

Colon only (including rectum)

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11
Q

Which layers of the gut wall does UC affect?

A

Confined to mucosa

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12
Q

What does the body fail to absorb in UC and why?

A

H2O as this is absorbed in the colon

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13
Q

What are the signs/ symptoms of IBD (3)?

A
  • Pain abdomen
  • Weight loss
  • Diarrhoea
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14
Q

Which IBD is bloody, mucous diarrhoea more commonly found in?

A

UC

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15
Q

Where can pain specifically be felt in UC and Crohns?

A
  • Crohns = RLQ
  • UC = LLQ
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16
Q

When else can pain be felt in UC?

A

During defecation in the rectum (as ulcers can be found very far along)

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17
Q

What are some extra intestinal signs/ symptoms of IBD (4)?

A
  • Episcleritis / uveitis (eye inflammation)
  • Erythema nodosum / pyoderma gangrenosum (skin lesions)
  • Aphthmous mouth ulcers
  • Primary sclerosing cholangitis (only UC)
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18
Q

Which one of these 4 extra intestinal signs is more common in Crohns?

A

Aphthmous mouth ulcers (think Crohns even affects the mouth)

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19
Q

How is Crohns investigated (4)?

A
  • High CRP and faecal calprotectin
  • Endoscopy
  • Biopsy
  • Imaging e.g. mri, xray (check for complications)
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20
Q

What would a Crohns endoscopy show?

A

Skip lesions + cobblestoning, strictures (narrowed area)

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21
Q

What would a Crohns biopsy show?

A

Transmural inflammation, non caseating granulomas (not from infection)

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22
Q

What is faecal calprotectin?

A

Released by intestines when inflamed

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23
Q

How is UC investigated?

A
  • High CRP and faecal calprotectin
  • Colonoscopy
  • Biopsy
  • Imaging (check for complications)
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24
Q

What would a UC colonoscopy show?

A

Continuous ‘lead pipe’ appearance

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25
Q

What would a UC biopsy show?

A

Mucosal inflammation with crypt hyperplasia + abscesses

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26
Q

How is IBD treated with medication for flares?

A

THIS IS WRONG, re-write flash card
1. Sulfasalazine
2. Prednisolone (steroid)

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27
Q

How is IBD treated with medication during remission?

A

THIS IS WRONG, re-write all IBD treatment flashcards
1. Azathioprine
2. Methotrexate

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28
Q

What drug can be used if others do not work for IBD?

A

Infliximab (monoclonal antibody)

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29
Q

How else can IBD be treated (non pharmacologically)?

A

Surgery

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30
Q

What are some complications of Crohns (4)?

A
  • Fistula
  • strictures
  • Abscesses
  • Bowel obstruction
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31
Q

What is a serious complication of UC?

A

Toxic megacolon

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32
Q

What is coeliacs disease?

A

Autoimmune condition where exposure to gluten –> inflammation of small bowel

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33
Q

What type hypersensitivity is coeliacs disease?

A

Type 4

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34
Q

What genes have been associated with coeliacs disease?

A
  • HLA-DQ2
  • HLA-DQ8
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35
Q

What part of gluten causes coeliacs disease?

A

Prolamines in gluten (alpha gliadin)

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36
Q

What 2 auto antibodies are produced in coeliacs disease?

A
  • Anti-tissue transglutaminase (anti-tTG)
  • Anti-endomysial (anti-EMA)
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37
Q

What has coeliacs disease been associated with?

A
  • T1DM
  • Autoimmune thyroid diseases
    Some other autoimmune diseases (in GI/hep system)
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38
Q

Which part of the small intestine is most commonly affected in coeliacs?

A

Proximal Jejunum, duodenum (biopsy taken from duo)

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39
Q

What are signs/ symptoms of coeliacs disease (4)?

A
  • Anaemia
  • Weight loss/ failure to thrive
  • Diarrhoea/ steatorrhoea (fat in shit)
  • Dermatitis herpetiformis
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40
Q

What causes anaemia in coeliacs disease?

A

Malabsorption (Fe, B12 and folate deficiency)

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41
Q

What is dermatitis herpetiformis?

A

Itchy blistery skin rash
In coeliacs

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42
Q

How is Coeliacs disease diagnosed?

A
  • Antibody testing
  • Duodenal biopsy = gold standard
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43
Q

Which antibodies are tested in Coeliacs disease?

A

tTg-IgA (anti-tissue transglutaminase IgA)

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44
Q

What can often cause a false negative result in coeliacs disease when measuring immunoglobulin presence?

A

IgA deficient patients

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45
Q

What antibody can be tested in IgA deficient patients who are suspected to have coeliacs?

A

tTg-IgG

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46
Q

What would a duodenal biopsy show in coeliacs?

A

Crypt hyperplasia + villous atrophy

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47
Q

How is coeliacs treated?

A

Don’t eat gluten

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48
Q

What is a differential diagnosis of coeliacs?

A

Tropical sprue (enteropathy (small intestine inflammation) associated with tropical travel)

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49
Q

What is IBS?

A

Functional disorder whereby the gut and nervous system don’t communicate effectively

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50
Q

What is a functional disorder?

A

No identifiable organic disease underlying the symtpoms

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51
Q

What has IBS been associated with?

A

Stress + anxiety

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52
Q

How can IBS present as (3 types)?

A
  • Constipation (IBS-C)
  • Diarrhoea (IBS-D)
  • Mixed (IBS-M)
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53
Q

What are the symptoms of IBS?

A
  • Abdominal pain
  • Bloating
  • Change in stool form and frequency
  • Mucous in stool (blood is rare)
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54
Q

How is IBS diagnosed?

A

Diagnosis of exclusion (normal bloods, coeliac tests)

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55
Q

How is IBS treated?

A
  1. Lifestyle advice, reassurance (e.g. fibre for constipation)
  2. Laxatives for constipation; Antimotility drugs for diarrhoea
  3. TCAs, SSRIs (CBT if they don’t work)
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56
Q

Give an example of a laxative used for IBS?

A

Senna

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57
Q

Give an example of an antimotility drug used for IBS?

A

Loperamide

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58
Q

Give an example of a TCA for IBS?

A

Amitriptyline

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59
Q

Give an example of an SSRI for IBS?

A

Citalopram

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60
Q

What is gastro oesophageal reflux disease?

A

Reflux of gastric acid though the lower oesophageal sphincter irritating the lining of the oesophagus

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61
Q

What can cause GORD (4)?

A
  • Obesity/ pregnancy
  • Hiatal hernia (stomach bulges through abdomen)
  • Drugs (e.g. antimuscarinics)
  • Scleroderma (thickened/ hardened LOS)
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62
Q

What are the symptoms of GORD (3)?

A
  • Heartburn (pain behind sternum)
  • Cough (especially at night)
  • Dysphagia (bad sign)
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63
Q

What position are the symptoms worst?

A

Lying on right hand side

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64
Q

How is GORD investigated?

A
  • If no ‘red flags’ start treatment
  • Otherwise refer for endoscopy
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65
Q

What are red flag symptoms for GORD (3)?

A
  • Dysphagia
  • Haematemesis (vomiting blood)
  • Weight loss
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66
Q

How is GORD treated?

A
  1. Lifestyle changes (smaller meals, weight loss, no caffeine, alcohol)
  2. Medications
  3. Surgery
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67
Q

What medications are used in GORD (3)?

A
  • PPIs
  • Antacids (neutralise stomach acid)
  • H2 receptor antagonists
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68
Q

What is an example of a PPI used for GORD (2)?

A
  • Omeprazole
  • Lansoprazole
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69
Q

What is an example of an antacid used for GORD?

A

Gaviscon

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70
Q

What is a side effect of antacids?

A

Diarrhoea

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71
Q

What is an example of a H2 receptor antagonist?

A

Ranitidine

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72
Q

Where are H2 receptors found in the stomach and what do they do?

A

On parietal cells (cause parietal cells to release gastric acid)

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73
Q

What cell releases histamine in the stomach?

A

Enterochromaffin like cells

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74
Q

What are 2 complications of GORD?

A
  • Oesophageal strictures
  • Barrets oesophagus
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75
Q

How are oesophageal strictures treated?

A

Endoscopic oesophageal dilation

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76
Q

What is Barrets oesophagus?

A

Change in oesophagus epithelium from stratified squamous to simple columnar (metaplasia)

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77
Q

What is the change in cells seen in Barrets oesophagus known as?

A

Metaplasia

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78
Q

What is dysplasia?

A

Morphological changes seen in cells in the progression to becoming cancer. The cells become more ‘jumbled up’

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79
Q

What is a Mallory Weiss tear?

A

Tear in mucosal layer of lower oesophagus

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80
Q

What causes a Mallory Weiss tear?

A

Sudden increase in intra-abdominal pressure (due to coughing or vomiting)

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81
Q

What are some risk factors for Mallory Weiss tear (4)?

A
  • Alcohol (makes you sick)
  • Chronic cough
  • Bulimia
  • Hyperemesis gravidarum
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82
Q

What is hyperemesis gravidarum?

A

Severe vomiting during pregnancy

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83
Q

What would a history of portal hypertension and liver disease suggest, rather than Mallory Weiss tears?

A

Oesophageal varices rupture

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84
Q

What are the symptoms of Mallory Weiss tear (3)?

A
  • Haematemesis
  • Pain in chest
  • Hypotensive if severe
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85
Q

How is a Mallory Weiss tear diagnosed?

A

Endoscopy

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86
Q

What score is used to determine the severity of an upper GI bleed?

A

Rockall score

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87
Q

How is Mallory Weiss tear treated?

A

Most spontaneously heal in 24 hours

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88
Q

What are the two main types of peptic ulcer?

A
  • Gastric ulcer
  • Duodenal ulcer
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89
Q

Which type of peptic ulcer is most common?

A

Duodenal ulcers

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90
Q

What is a peptic ulcer?

A

A gap in the mucosal lining of the stomach or small intestine that allows acid and digestive enzymes to contact the inner layers

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91
Q

Which type of peptic ulcer is most common?

A

Duodenal ulcer

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92
Q

Which part of the duodenum is most commonly affected by ulcers?

A

D1/D2 posterior wall

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93
Q

Which part of the stomach is most commonly affected by ulcers?

A

Lesser curve

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94
Q

What are the causes of peptic ulcers (3)?

A
  • H-pylori
  • NSAIDs
  • Zollinger Ellison syndrome
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95
Q

What is Zollinger Ellison Syndrome?

A

Gastrinoma (gastrin secreting tumour), most commonly occurs in the stomach, duodenum or pancreas

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96
Q

Which of those 3 causes is most common in duodenal ulcers?

A

H-pylori

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97
Q

What are the symptoms general symptoms of a peptic ulcer (4)?

A
  • Dyspepsia
  • N+V
  • Abdominal pain
  • Haematemesis
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98
Q

What are the specific symptoms of a gastric ulcer (2)?

A
  • Worse on eating
  • Weight loss (?maybe because they don’t want to eat?)
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99
Q

What are the specific symptoms of a duodenal ulcer (2)?

A
  • Improves on eating
  • Weight gain (?maybe they want to eat to take the pain away?)
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100
Q

How are peptic ulcers investigated (3)?

A
  • Urea breath test (for H-pylori)
  • Stool antigen test (for H-pylori)
  • Endoscopy + biopsy
101
Q

How are peptic ulcers treated?

A

Treat underlying cause (e.g. stop NSAIDs/ treat H-pylori)

102
Q

How is H-pylori treated?

A

Triple therapy

103
Q

What does triple therapy for H-pylori involve?

A
  • Clarithromycin
  • Amoxicillin
  • PPIs
104
Q

What is a complication of peptic ulcers?

A

Bleeding

105
Q

Which artery is commonly eroded in gastric ulcers?

A

Left gastric

106
Q

Which artery is commonly eroded in duodenal ulcers?

A

Gastroduodenal artery

107
Q

What is gastritis?

A

Gastric mucosal inflammation and injury

108
Q

What is gastropathy?

A

Damage to the mucosal lining, without inflammation

109
Q

What causes gastritis (3)?

A
  • Autoimmune (related to pernicious anaemia - anti IF ABs)
  • Infective
  • Mucosal ischemia
110
Q

What bacteria most commonly causes gastritis?

A

H-pylori

111
Q

What can cause gastropathy?

A

NSAIDs (don’t usually cause inflammation, just damage)

112
Q

Symptoms of gastritis (4)?

A
  • Epigastric pain
  • Diarrhoea
  • N+V
  • Indigestion
113
Q

How is gastritis investigated?

A

Endoscopy + biopsy (test for causes)

114
Q

What is a complication of gastritis?

A

Peptic ulcers

115
Q

What is an appendicitis?

A

Inflamed appendix

116
Q

What can cause an appendicitis other than infection (3)?

A
  • Faecolith (hardened faeces)
  • Lymphoid hyperplasia of Peyer’s patches (blocks appendix)
  • Filarial worms
117
Q

What are some examples of mucosa associated lymphoid tissue (MALT) (2)?

A
  • Peyers patches
  • Tonsils
118
Q

What bacteria most commonly found in appendicitis?

A

Escherichia coli (E. coli)

119
Q

Symptoms/ signs of appendicitis (5)?

A
  • Umbilical pain that localises to McBerney’s point
  • Tenderness and guarding (tensing of muscles)
  • Rosving sign
  • Obturator sign
  • Psoas sign
120
Q

What is rosving sign?

A

Pressing in LLQ causes RLQ pain

121
Q

Where is McBurneys point?

A

2/3rds the way from the naval to the right anterior superior iliac spine

122
Q

How is an appendicitis diagnosed (3)?

A
  • Symptoms/ examination
  • Ultrasound
  • CT = gold standard (if unsure)
123
Q

How is an appendicitis treated?

A
  • Abx
  • Appendectomy (laproscopic)
124
Q

Complications of appendicitis (2)?

A
  • Spontaneous bacterial peritonitis (SBP)/ rupture
  • Abscess
125
Q

What is a diverticulum?

A

Out pouching of colonic mucosa

126
Q

What is diverticulosis?

A

Asymptomatic diverticulum

127
Q

What is diverticular disease?

A

Symptomatic outpouching of the colonic mucosa

128
Q

What is diverticulitis?

A

Infected/ inflamed diverticulum

129
Q

What percentage of diverticulum are asymptomatic?

A

95%

130
Q

What is Meckel’s diverticulum?

A

Embryological remnant of the attachment of the midgut to yolk sac (1 meter from termination of ileum)

131
Q

What are some risk factors/ causes of diverticulum (4)?

A
  • Connective tissue disorders (EDS/marfans)
  • Ageing
  • High colon pressure
  • Chronic cough (COPD)
132
Q

What are the symptoms of diverticular disease (3)?

A
  • LLQ pain
  • Constipation
  • Rectal bleeding (fresh/ red)
133
Q

How is diverticulum diagnosed?

A
  • CT scan with contrast = gold standard
  • Colonoscopy
134
Q

How are the diverticulum conditions treated?

A
  • Laxatives (for symptoms)
  • Surgery (not usually for diverticulitis)
  • Abx (for infection)
135
Q

What are some complication of diverticulitis?

A
  • Spontaneous bacterial peritonitis (SBP)
  • Obstruction
  • Fistulae
136
Q

What is a bowel obstruction?

A

Mechanical obstruction that prevents food passing through the intestines

137
Q

What type of bowel obstruction is far more common?

A

Small bowel obstruction

138
Q

What causes small bowel obstructions most commonly (2)?

A
  • Adhesions
  • Hernias (through abdominal wall)
139
Q

What causes large bowel obstructions (3)?

A
  • Malignancy
  • Diverticular disease
  • Volvulus (loop of intestine twists around itself)
140
Q

What locations can bowel obstructions be divided into?

A
  • Intraluminal (faecal compaction, gallstone ileus)
  • Mural (cancer, strictures, intussusception)
  • Extramural (hernias, adhesions, volvulus)
141
Q

What is intussusception?

A

Telescoping of intestine

142
Q

What are the symptoms of a bowel obstruction (4)?

A
  • Abdominal pain (colicky)
  • Vomiting
  • Constipation
  • Distension
143
Q

What is the order of symptoms in proximal (SBO) and distal (LBO) obstruction?

A
  • Proximal = vomiting first, then constipation
  • Distal = constipation first, then vomiting
144
Q

How are bowel obstructions diagnosed (2)?

A
  • AXR (distended loops of bowels, transluminal gas shadows)
  • CT abode with contrast = gold standard (dilated bowel loops)
  • Bloods (monitor U&Es)
145
Q

How do you treat bowel obstruction (4)?

A
  • Fluid resus
  • NG tube
  • Abx
  • Surgery last resort
146
Q

What is a pseudo obstruction of the bowels?

A

No mechanical obstruction problem with; peristalsis may stop (known as ileus)

147
Q

What is diarrhoea defined as?

A

3+ loose stools per day (frequency + consistency)

148
Q

What chart measures stool consistency?

A

Bristol stool chart

149
Q

What is normal on the Bristol stool chart?

A

3 and 4

150
Q

What is the name for bloody diarrhoea?

A

Dysentery

151
Q

What are 4 types of diarrhoea by constituents?

A
  • Watery (IBS-D)
  • Steatorrhoea (fat)
  • Inflammatory (normal constituents)
  • Haemorrhagic
152
Q

What are the three types of diarrhoea by time frame?

A
  • Acute <14 days
  • Sub-acute 14-28 days
  • Chronic >28 days
153
Q

What causes diarrhoea (7)?

A
  • IBD
  • Coeliacs
  • Hyperthyroidism
  • IBS
  • Malignancy (cancer/ tumour)
  • Infective
  • Medications
154
Q

What are the most common viruses to cause diarrhoea in kids and adults?

A

Kids = rotavirus
Adults = norovirus

155
Q

What bacteria cause diarrhoea most commonly (5)?

A
  • Campylobacter = most common
  • C. difficile
  • Escherichia coli
  • Sallmonella
  • Cholera
156
Q

What other infective thing can cause diarrhoea?

A

Worms!!!!!! yucky yucky yucky

157
Q

What do antibiotics increase the risk of?

A

Infection (particularly C. difficile)

158
Q

What causes giardiasis?

A

Parasites (amoeba histolytica)

159
Q

What can campylobacter sometimes cause?

A

Guillain Barre syndrome

160
Q

What are the two common types of oesophageal cancer?

A
  • Adenocacinoma
  • Squamous cell carcinoma
161
Q

Where are both these types of oesophageal cancer found most commonly (which part of oesophagus)?

A
  • Adenocarcinoma = bottom 2/3rds
  • Squamous cell carcinoma = top 2/3rds
162
Q

What are the symptoms of oesophageal cancer (6)?

A
  • Anaemia
  • Loss of weight
  • Anorexic
  • Recent sudden symptoms worsening
  • Melinia/ Haematemesis
  • Swallowing issues (dysphagia)
    ALARMS
163
Q

How is oesophageal cancer diagnosed and investigated (3)?

A
  • Gastroscopy + biopsy
  • Barium swallow (shows up when series of x rays taken)
  • CT (for staging)
164
Q

How is oesophageal cancer treated (2)?

A
  • Radio/chemotherapy
  • Surgery
165
Q

What is achalasia?

A

Nerves in oesophagus stop working (can be confused with oesophageal cancer)

166
Q

What is the most common type of gastric carcinoma?

A

Adenocarcinoma

167
Q

What is an adenocarcinoma?

A

Glandular epi malignant tumour

168
Q

What are the two types/ severities of gastric cancer?

A
  • T1 = ‘well differentiated’ only in mucosal layer
  • T2 = ‘undifferentiated’ in muscular própria layer of stomach
169
Q

What are some causes/ risk factors for gastric carcinomas (4)?

A
  • H. pylori
  • Smoking
  • Family history/ genetics
  • Pernicious anaemia (autoimmune chronic gastritis)
170
Q

What gene increases risk of mutation in stomach cancer?

A

CDH-1 mutation (cadherin gene)

171
Q

What are the symptoms of gastric carcinomas (5)?

A
  • Severe epigastric pain
  • Anaemia
  • Weight loss
  • Fatigue
  • Progressive dysphagia
172
Q

Where do gastric tumours commonly metastasise to and what can this cause?

A

Liver –> jaundice

173
Q

What is a krukenberg metastasis?

A

Tumour metastasis to the ovary

174
Q

How is gastric carcinoma diagnosed?

A

Endoscopy + biopsy

175
Q

How does the TNM grading of tumours work?

A
  • T = size + extent of main tumour
  • N = lymph nodes affected
  • M = extent of tumour metastases
176
Q

How are gastric carcinomas treated (2)?

A
  • Surgery
  • ECF regimen (types of chemo used together)
177
Q

Are small intestine tumours common?

A

No, you idiot

178
Q

What is the most common type of SI cancer?

A

Adenocarcinoma

179
Q

What are some risk factors for SI cancers?

A

Chronic SI disease (e.g. crohns, coeliacs)

180
Q

What are common benign polyps in the large intestine known as?

A

Adenoma

181
Q

What is the most common type of colorectal cancer and can polyps in the large intestine progress to?

A

Adenocarcinomas

182
Q

What are some risk factors/ causes of colorectal cancer (4)?

A
  • Genetic/ familial
  • Alcohol
  • Smoking
  • IBD
183
Q

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

A
  • Familial adenomatous polyposis (FAP), (APC gene mutation)
  • Hereditary non polyposis colon cancer (Lynch syndrome), (MLH 1/2 gene mutated)
184
Q

How are FAP and Lynch syndrome inherited?

A

Autosomal dominant

185
Q

Where does colorectal cancer commonly metastasise to?

A

Liver and lung

186
Q

What part of the bowel do tumours most commonly occur in?

A

Rectum (most common); distal colon (sigmoid onwards)

187
Q

What are the symptoms of colorectal cancer (4)?

A
  • LLQ pain
  • Bloody stool
  • Change in bowel habits
  • Tenesmus (feeling of needing to pass stool)
188
Q

How is colorectal cancer diagnosed?

A
  • Faecal immunochemical test (FIT)
  • Colonoscopy + biopsy
189
Q

What is the treatment for colorectal cancer?

A

Surgery + chemo

190
Q

What is the presentation of people with dyspepsia (3)?

A
  • Early satiation
  • Epigastric pain + reflux
  • Extreme fullness
191
Q

What are 3 common bacteria that infect the gut?

A
  • Helicobacter pylori
  • Escherichia coli
  • C difficile
192
Q

How does Helicobacter pylori cause peptic ulcers (2 ways)?

A
  • Increase acidity
  • Produce ammonia (toxic to epithelial cells)
193
Q

How does h pylori produce ammonia?

A

Produces urease which converts urea to ammonia which damages the epithelial cells

194
Q

How does h pylori increase acidity?

A
  • Decrease somatostatin production –> increases gastric acid production
  • Decreases HCO3- secretion
195
Q

What does h pylori cause (3)?

A
  • Peptic ulcers
  • Gastritis
  • Adenocarcinoma
196
Q

How is h pylori diagnosed (2)?

A
  • Antigen stool test
  • Urea breath test
197
Q

How is h pylori treated (3)?

A

Triple therapy: clarythromycin, amoxicillin and PPIs

198
Q

What often induces c difficile infection?

A

Antibiotic use (kills healthy bacteria)

199
Q

What is a complication of c difficile?

A

Pseudomembranous colitis (swelling + inflammation of intestines)

200
Q

What is achalasia?

A

Dysmotility of the GI tract (impaired peristalsis)

201
Q

Where does achalasia most commonly affect?

A

Oesophagus (at LOS)

202
Q

What kind of dysmotility does oesophageal achalasia usually result in?

A

Failure of smooth muscle to relax

203
Q

What are the symptoms of oesophageal achalasia (3)?

A
  • Non-progressive dysphagia
  • Substernal pain
  • Aspiration pneumonia (food regurg)
204
Q

How is achalasia diagnosed (2)?

A
  • Barium swallow test
  • Manometry (measure pressure down oesophagus)
205
Q

How is achalasia treated (3)?

A
  • Surgery (extend stomach past LOS)
  • Balloon dilation
  • Medications
206
Q

What medications are used in people with achalasia (2)?

A
  • Nitrates
  • Nifedipine (CCB)
207
Q

What are some complications of achalasia (2)?

A
  • Barrets oesophagus
  • Aspiration pneumonia
208
Q

What is ischemic colitis?

A

Ischemia of colonic arterial supply –> inflammation of colon

209
Q

Which arteries can be affected by ischemic colitis?

A
  • SMA (duodenum –> 2/3rds way along transverse colon)
  • IMA (2/3rds way along transverse colon –> rectum)
210
Q

What causes ischemic colitis (3)?

A
  • Atherosclerosis
  • Arrhythmias (e.g. AF)
  • Bowel obstruction/ twisting of intestine (volvulus)
211
Q

Which parts of the colon are most commonly affected by ischemic colitis (3)?

A
  • Splenic flexure most common
  • Sigmoid colon
  • Caecum
    Supplied by most distal branches of arteries
212
Q

What are the symptoms/ signs of ischemic colitis (2)?

A
  • LLQ pain
  • Blood in stool
213
Q

How is ischemic colitis diagnosed?

A

Colonoscopy with biopsy = gold standard (done after patient recovered)

214
Q

How is ischemic colitis treated?

A
  • IV fluids
  • Antibiotics (prophylactic)
  • Surgery (if infarcted + gangrenous)
215
Q

What are some complications of ischemic colitis?

A
  • Perforation = peritonitis
  • Strictures = bowel obstruction
216
Q

What is mesenteric ischemia?

A

Ischemia of mesenteric vessels supplying mainly the small intestines

217
Q

Which parts of the colon have a mesentery?

A

Transverse and sigmoid

218
Q

What are the two classifications of mesenteric ischemia?

A
  • Acute (abdominal MI)
  • Chronic (abdominal angina)
219
Q

What are the symptoms/signs of acute mesenteric ischemia (2)?

A
  • Severe abdominal pain
  • No guarding
220
Q

What are the symptoms/ signs of chronic mesenteric ischemia?

A
  • Colicky abdo pain after eating
  • Weight loss
  • Abdominal bruit (heard on auscultation)
221
Q

How is mesenteric ischemia diagnosed?

A
  • CT angiogram
  • Bloods = metabolic acidosis
222
Q

How is mesenteric ischemia treated?

A
  • Fluids
  • Abx (prophylactic)
  • Heparin
  • Surgery
223
Q

What are some complications of mesenteric ischemia?

A
  • Acute bacterial peritonitis (after perforation)
  • Strictures
224
Q

What are haemorrhoids?

A

Swollen veins in and around anus that can prolapse through

225
Q

What causes haemorrhoids (3)?

A
  • Constipation
  • Being overweight/ pregnant
  • Anal sex
226
Q

What are the two types of haemorrhoid?

A
  • Internal
  • External
227
Q

What defines an internal vs external haemorrhage?

A

Originate above/ below internal rectal plexus (Dentate line)

228
Q

Which type of haemorrhage is more painful?

A

External (has more nerve supply)

229
Q

What are the symptoms of a haemorrhoid (5)?

A
  • Bright red (fresh) blood in stool
  • Bulging pain
  • Itchy bum (pruritus ani)
  • Mucous in stool
  • Need to defecate after emptying bowels
230
Q

How are haemorrhoids diagnosed (2)?

A
  • Digital rectal exam
  • Proctoscopy (look inside anus)
231
Q

How are haemorrhoids treated (2)?

A
  • Stool softener
  • Rubber band ligation (rubber band put round haemorrhoid and they drop off)
232
Q

What is a perianal abscess?

A

Walled off collection of stool and bacteria around anus

233
Q

What causes perianal abscesses (2)?

A
  • Anal sex
  • IBD
234
Q

What are some symptoms of perianal abscesses (2)?

A
  • Pus in stool
  • Tender + painful
235
Q

How is a perianal abscess treated?

A

Surgical removal + drainage

236
Q

What is an anal fistula?

A

Abnormal track/ connection between anal canal and elsewhere (usually skin)

237
Q

What causes anal fistulas (2)?

A
  • Progression from abscess
  • Rectal cancer
238
Q

What are the symptoms of an anal fistula (2)?

A
  • Bloody pusy stool
  • Painful
239
Q

How is an anal fistula treated?

A

Surgery (removal + drainage) with antibiotics

240
Q

What is an anal fissure?

A

Tear in anal skin lining below dentate line (very painful)

241
Q

What causes anal fissure (4)?

A
  • Hard faeces
  • Child birth
  • Anal sex
  • IBD
242
Q

What are the symptoms of anal fissure (3)?

A
  • Painful
  • Itchy
  • Bloody stool
243
Q

How is anal fissure treated (2)?

A
  • Stool softeners (fibre + more fluids)
  • Topical creams
244
Q

What is a pilonidal sinus?

A

Hair follicle gets stuck in skin

245
Q

What is it called when a pilonidal sinus becomes infected?

A

Pilonidal abscess

246
Q

What is zenkers diverticulum?

A

Pharyngeal pouch - food gets caught in pouch at back of oesophagus

247
Q

What are the symptoms of zenkers diverticulum (2)?

A
  • Smelly breath
  • Regurgitation of food
248
Q

What viral infection in the gut is indicative of AIDs?

A

Cytomegalovirus (owl eye colitis)

249
Q

What can cytomegalovirus cause in the large intestines?

A

Pseudomembranous colitis

Phase 2a flashcards (Alec's) (13 decks)

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