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GI Flashcards

1
Q

Define Gastro-Oesophageal Reflux Disease (GORD)

A

Reflux of stomach contents causing 2 or more heartburn episodes/week

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2
Q

Aetiology of GORD

A
  1. Lower oesophageal sphincter hypotension
  2. Hiatus hernia
    • sliding hiatus hernia = gastro-oesophageal junction + part of stomach slides up into chest above diaphragm
    • Rolling hiatus = part of fundus of stomach prolapses through hiatus alongside oesophagus
  3. Loss of oesophageal peristaltic function
  4. Abdomen obesity
  5. Drugs - antimuscarinic, CCB, nitrates
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3
Q

Clinical presentation of GORD

A
  1. Heartburn
  2. Belching
  3. Food/acid brash
  4. Water brash
  5. Painful swallowing
  6. Nocturnal asthma
  7. Chronic cough
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4
Q

What are some differential diagnoses for GORD

A
  1. CAD
  2. Biliary colic
  3. Peptic ulcer disease
  4. Malignancy
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5
Q

Diagnosis of GORD

A
  1. Diagnosis usually possible without investigation UNLESS alarm bell signs such as weight loss, haematemesis (coughing up blood), trouble swallowing
  2. Investigations if alarm bell signs
    • Endoscopy
      • If endoscopy normal - do 24h oesophageal pH monitor
    • Barium swallow
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6
Q

Treatment of GORD

A

LIFESTYLE
1. Weight loss
2. Smoking cessation
3. Small regular meals
4. avoid hot drinks, alcohol, citrus, food < 3h before bed
MEDICAL
1. ANTACIDS - Mg Trisilicate mixture
2. Alginates - Gaviscon
3. PPI - Lansoprazole
4. H2 receptor antagonist - Cimetidine
SURGICAL
1. Nissen fundoplication - laparoscopically increase resting LOS pressure

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7
Q

Complications of GORD

A
  1. Peptic stricture
    • Inflammation of oesophagus -> narrowinf of oesophagus
  2. Barrett’s oesophagus
    • Distal oesophageal epithelium undergoes metaplasia: squamous -> columnar
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8
Q

What are the 2 major forms of IBD

A
  1. Ulcerative colitis - affects only COLON
  2. Crohn’s disease - ANY PART OF GI
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9
Q

Define IBD

A

Mucosal immune system exerts inappropriate response to luminal antigens

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10
Q

Define ulcerative Colitis

A
  1. Relapsing and remitting inflammatory disorder of colonic mucosa
  2. May effect entire colon UP TO ileocaecal valve, NEVER proximal to it
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11
Q

Risk factors of UC

A
  1. Family history
  2. NSAIDS
  3. Chronic stress & depression
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12
Q

Pathophysiology of UC

A
  1. Restricted mucosal disease - differentiates from Crohn’s
  2. Affects only colon
  3. Circumferential and continuous inflammation - NO SKIP LESIONS
  4. Mucosal inflammation - DOES NOT GO DEEPER
  5. No granulomata
  6. Depleted goblet cells
  7. Increased crypt abscesses
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13
Q

Clinical presentation of UC

A
  1. Remissions and exacerbations
  2. Pain restricted to lower left quadrant
  3. Episodic or chronic diarrhoea with blood and mucus
  4. Cramps
  5. Tachycardia
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14
Q

Diagnosis of UC

A
  1. Blood test
    • Raised WCC and platelets
    • Iron deficient anaemia
    • ESR and CRP raised
  2. Stool sample to exclude C.diff etc
    CAROTECTIN
  3. Colonoscopy with mucosal biopsy (GOLD STANDARD)
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15
Q

What organs can be involved in complications with UC

A
  1. Liver
  2. Colon
  3. Skin
  4. Joints
  5. eyes
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16
Q

Treatment of UC

A

1st line - Oral or IV Corticosteroid

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17
Q

Define Crohn’s Disease (CD)

A
  1. Chronic inflammatory GI disease
  2. Transmural granulomatous inflammation
  3. Affecting any part of gut from mouth to anus
  4. Skip lesions
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18
Q

Pathophysiology of CD

A
  1. Transmural granulomatous with skip lesions
  2. Inflammation affects any part of gut
  3. Affects terminal ileum and proximal colon in particular
  4. Involved bowel = thickened and narrowed
  5. Cobblestone appearance due to ulcers and fissures in mucosa
  6. Goblet cells present
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19
Q

Clinical presentation of CD

A
  1. Diarrhoea with urgency, bleeding and pain
  2. Abdominal pain - acute right iliac fossa pain mimics appendicitis
  3. Weight loss
  4. Lethargy
  5. Perianal abscess
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20
Q

Complications of CD

A
  1. Perforation and bleeding
  2. Fistula formation
  3. Malabsorption
  4. Toxic dilation of colon
  5. Colorectal cancer
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21
Q

Differential diagnosis of CD

A
  1. Alternative causes of diarrhoea must be excluded (salmonella etc)
  2. Chronic diarrhoea
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22
Q

Diagnosis of CD

A
  1. Tenderness of right iliac fossa
  2. Anal examination
  3. Bloods
    • Anaemia - due to malabsorption
      • deficiency of iron and folate
    • Raised ESR and CRP
    • Raised WCC and platelets
  4. Stool sample to exclude C.difficile
  5. Colonoscopy
    • Biopsy for spot lesions and granulomatous transmural inflammation
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23
Q

Treatment of CD

A
  1. Smoking cessation
  2. Anaemia - Iron,B12 or folate replacement
  3. Mild attacks
    • Controlled release corticosteroids - BUDESONIDE
  4. Moderate to severe attacks
    • Glucosteroids - Oral PREDNISOLONE
  5. Severe attacks
    • IV HYDROCORTISONE
    • Antibiotics - IV METRONIDAZOLE
  6. If no improvement
    • Anti-TNF antibodies - INFLIXIMAB
  7. Maintain remission
    • AZATHIOPRINE
  8. Surgery
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24
Q

Define IBS

A
  1. Mixed group of abdominal symptoms
  2. No organic cause can be found
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25
Q

What are the 3 types of IBS

A
  1. IBS -C - with constipation
  2. IBS-D - with diarrhoea
  3. IBS-M - with both
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26
Q

Risk factors of IBS

A
  1. Female
  2. Previous severe and long diarrhoea
  3. High hypochondrial anxiety and neurotic score at time of illness
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27
Q

Pathophysiology of IBS

A

Dysfunction in brain-gut axis -> disorder of intestinal motility

28
Q

Clinical presentation of IBS

A
  1. Multisystem disorder with non-intestinal symptoms
    • Painful period
    • Urinary frequency
    • Back pain
    • Joint hyper-mobility
  2. Consider IBS if any of ABC presented
    • A - Abdominal pain
    • B - Bloating
    • C - Change in bowel habit
  3. Symptoms worsened by stress and menstruation
  4. RED FLAG SYMPTOMS
    • Unexplained weight loss
    • PR bleed
    • Family history of bowel or ovarian cancer
29
Q

Differential diagnosis of IBS

A
  1. Coeliac disease
  2. Lactose intolerance
  3. Bile acid malabsorption
  4. IBD
  5. Colorectal cancer
30
Q

Diagnosis of IBS

A
  1. Nothing physical to be found .˙. must rule out differentials
  2. Bloods
    • FBC - anaemia
    • ESR & CRP - inflammation
    • Coeliac serology - test EMA and tTG (+ve = coeliac)
  3. Faecal calprotectin - raised in IBD
  4. Colonoscopy - rule out IBD
31
Q

Treatment of IBS

A
  1. Regular small meals
  2. Reduce caffeinated drinks, alcohol and fizzy
  3. IBS-D -> insoluble fibre intake
  4. Pain -> antispasmodics - MEBEVERINE
  5. Constipation -> laxative - MAVICOL
  6. Diarrhoea -> anti motility agent - LOPERAMIDE
  7. LAST RESORT -> SSRI
32
Q

Define coeliac disease (Gluten sensitivity enteropathy)

A
  1. Inflammation of mucosa of upper small bowel
  2. Improves when gluten withdrawn
  3. Relapses when gluten reintroduced
  4. T cell mediated autoimmune disease in which PROLAMIN intolerance causes villous atrophy and malabsorption
33
Q

Pathophysiology of Coeliac Disease

A
  1. PROLAMIN A-GLIADIN toxic and resistant to digestion by pepsin and chymotrypsin
  2. End up remaining in intestinal lumen -> immune response triggered
  3. gluten sensitive T cells activated
  4. T cells produce pro-inflammatory cytokines
  5. Inflammatory cascade initiated
  6. Cascade releases metaloproteinkinases
    -> Villous atrophy
    -> Crypt hyperplasia
    -> Intraepithelial lymphocytes
34
Q

Clinical presentation of Coeliac Disease

A
  1. 1/3 = asymptomatic
  2. Smelly/fatty stool
  3. Diarrhoea
  4. Abdominal pain
  5. Bloating
35
Q

Diagnosis of Coeliac Disease

A

FIRST LINE - IgA-tTG serology with gluten diet
2. FBC
- Low Hb
- Low B12
- Low ferritin
3. DUODENAL BIOPSY = GOLD STANDARD

36
Q

Treatment of Coeliac Disease

A
  1. Remove gluten
  2. Correction of vitamins and mineral
  3. DEXA scan to monitor osteoporotic risk
37
Q

Define gastritis

A

Inflammation associated with mucosal injury

38
Q

Aetiology of gastritis

A
  1. Helicobacter pylori infection
  2. Autoimmune gastritis
  3. Viruses
  4. Duodenogastric reflux
  5. NSAIDS
39
Q

Pathophysiology of gastritis

A
  1. H. Pylori -> severe inflammatory response
    • Gastric mucus degradation + increased mucosal permeability = cytotoxic to gastric epithelium
  2. Autoimmune gastritis
    • affects fundus and body of stomach
      -> atrophic gastritis + loss of parietal cells & intrinsic factor deficiency
      ->pernicious anaemia
40
Q

Clinical presentation of gastritis

A
  1. N+V
  2. Abdominal bloating
  3. Epigastric pain
  4. Indigestion
  5. Haematemesis (blood vomit)
40
Q

Differential diagnosis of gastritis

A
  1. Peptic ulcer disease (PUD)
  2. GORD
  3. Non-ulcer dyspepsia
  4. Gastric lymphoma
  5. Gastric carcinoma
40
Q

Diagnosis of gastritis

A
  1. FBC - leukocytosis
  2. H.pylori urea breath test
  3. H.pylori stool antigen test
  4. Endoscopy
  5. Biopsy
41
Q

Treatment of gastritis

A
  1. Remove causative agents
  2. Reduce stress
  3. H.pylori eradication
  4. TRIPLE THERAPY
    • Acid suppression - PPI (LANSOPRAZOLE/OMEPRAZOLE)
    • METRONIDAZOLE/CLARITHROMYCIN
    • AMOX/TETRACYCLINE
  5. Acid suppression - H2 ANTAGONIST (RANITIDINE)
42
Q

Define peptic ulcer disease (PUD)

A
  1. Break in the superficial epithelial cells
  2. Penetrating down to muscularis mucosa
  3. Of stomach or duodenum
  4. Fibrous base + increase in inflammatory cells
43
Q

Aetiology of PUD

A
  1. H. Pylori infection
  2. NSAIDs, steroids, SSRIs
  3. Increased gastric acid secretion
  4. Smoking
  5. Delayed gastric emptying
44
Q

Pathophysiology of aetiology PUD

A
  1. NSAIDS -> Inhibit cyclo-oxygenase 1 .˙. reduced mucosal defence
  2. H. Pylori -> colonise gastric epithelium -> inhabit mucosa layer -> major destruction to mucin layer
45
Q

Clinical presentation of PUD

A
  1. Recurrent burning epigastric pain
    • single location pain = strong suggestion of PUD
    • duodenal ulcer = pain at night or hungry
    • antacid relieves pain
  2. Anorexia + weight loss
  3. RED FLAG SIGNS FOR CANCER
    • Anaemia
    • GI bleed
    • Dysphagia
    • Upper abdominal mass
46
Q

Complications of PUD

A
  1. Duodenal ulcer = deeper until hits artery -> massive haemorrhage
  2. Peritonitis as acid enters peritoneum
  3. Acute pancreatitis
47
Q

Diagnosis of PUD

A
  1. Non invasive test
    • serological test
    • breath test
    • stool antigen test
  2. Endoscopy
48
Q

Treatment of PUD

A
  1. Lifestyle adjustment
  2. Stop NSAIDs
  3. H. pylori eradication
49
Q

Define appendicitis

A
  1. Consider as possibility for all right sided pain
  2. Located at McBurney’s point - 2/3 of the way from umbilicus to Anterior superior iliac spine
50
Q

Aetiology of appendicitis

A
  1. Faecolith (faecal stones)
  2. Lymphoid hyperplasia
  3. Filarial worms
51
Q

Pathophysiology of appendicitis

A
  1. Lumen of appendix becomes obstructed
  2. Results in invasion of gut organism into appendix wall
  3. leads to oedema, ischaemia, necrosis, inflammation and perforation
  4. If appendix ruptures -> infected and faecal matter enters peritoneum -> life threatening peritonitis
52
Q

Clinical presentation of appendicitis

A
  1. Pain in umbilical region migrates to right iliac fossa
  2. Anorexia
  3. N+V
  4. Constipation
53
Q

Differential diagnosis of appendicitis

A
  1. Acute terminal ileitis
  2. Ectopic pregnancy
  3. UTI
  4. Diverticulitis
  5. Perforated ulcer
54
Q

Diagnosis of appendicitis

A
  1. Bloods
    • Raised WCC with neutrophil leucocytosis
    • Elevated CRP and ESR
  2. Ultrasound
    • detect inflamed appendix
  3. CT
    • GOLD STANDARD
  4. Pregnancy test - exclude pregnancy
  5. Urinalysis - exclude UTI
55
Q

Treatment of appendicitis

A
  1. Surgical - appendectomy
  2. IV antibiotic pre-op - METRONIDAZOLE, CEFUROXIME
56
Q

Define diverticulum

A

outpouching of gut wall at sites of entry of perforating arteries

57
Q

Types of diverticular disease

A
  1. Diverticulosis - presence of diverticula
  2. Diverticular disease - diverticula are symptomatic
  3. Diverticulitis - inflammation of diverticulum
58
Q

Aetiology of diverticular disease

A
  1. Low fibre diet
  2. Obesity
  3. Smoking
  4. NSAIDs
59
Q

Pathophysiology of diverticular disease

A
  1. Diverticula forms at gaps in wall of gut where blood vessels penetrate
  2. Low fibre -> colon pushes harder -> pressure increase
  3. Increased pressure -> pouches of mucosa extrude through muscular wall
  4. Thickening of muscle layer
  5. ACUTE DIVERTICULITIS
    • Faeces obstruct neck of diverticulum ->bacteria multiply -> inflammation
    • lead to bowel perforation, abscess, fistulae
60
Q

Clinical presentation of diverticular disease

A
  1. Asymptomatic in 95%
    • Detected incidentally on colonoscopy or barium enema
  2. IF SYMPTOMATIC
    • Intermittent left iliac fossa pain
    • Erratic bowel habit
  3. ACUTE DIVERTICULITIS
    • Diverticula in sigmoid colon
    • Severe pain in left iliac fossa
    • Fever + constipation
      SIMILAR TO APPENDICITIS BUT ON RIGHT SIDE
61
Q

Diagnosis of diverticular disease

A
  1. Colonoscopy if no clinical signs
  2. Bloods
    • Polymorphonuclear leucocytosis - increased levels of WBC
    • Elevated and ESR and CRP
  3. CT colonography
    • Best for diagnosis
62
Q

Define gastritis

A
  1. Inflammation with mucosal injury
  2. Epithelial cell damage and regen WITHOUT inflammation
63
Q

Differential diagnosis of gastritis

SJ Phase 2a (13 decks)

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