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medicine phase 2 a > GI > Flashcards

GI Flashcards

1
Q

What hypersensitivity is coeliac disease?

A

type 4 - t cell mediated

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2
Q

What type of protein is not tolerated in coeliac disease?

A

prolamin (a-gliadin)

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3
Q

What happens to a-gliadin when it is not digested?

A

it passes into cells and is deaminated by transglutaminase, it interacts with antigens and causes T-cells to produce and inflammatory response

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4
Q

What physiological change happens in the gut to cause symptoms of coeliac disease?

A

villous atrophy and crypt hyperplasia

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5
Q

What are the key presentations of coeliac disease?

A

malabsorption - weight loss
steatorrhea
anaemia (B12 deficiency)
fatigue
diarrhoea
abdominal pain

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6
Q

What can decreased vitamin D lead to in coeliac disease?

A

osteomalacia

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7
Q

What are the main complications of coeliac disease?

A

anaemia
malignancy - T cell lymphoma, GI cancers

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8
Q

What is the 1st line investigation for coeliac disease?

A

IgA tissue transglutaminase (TTG)

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9
Q

What is the gold standard investigation for coeliac disease?

A

duodenal biopsy

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10
Q

What would an FBC show in someone with coeliac disease?

A

low Hb
low folate
low ferritin
low B12

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11
Q

What areas of the bowel does ulcerative colitis (UC) effect?

A

ONLY the colon
starts at rectum - can progress to ileocaecal valve

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12
Q

What layer of the bowel does UC effect?

A

ONLY the mucosa but is circumferential and continuous

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13
Q

What may be present in severe UC?

A

ulcers and pseudo-polyps

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14
Q

What is a protective factor against UC?

A

smoking

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15
Q

What are the key presentations of UC?

A

remissions + exacerbations of symps
abdo pain/cramps - lower left quadrant
episodic chronic diarrhoea
systemic symptoms - fever, anorexia, weight loss

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16
Q

What are the colon related complications of UC?

A

blood loss
perforation
toxic dilation
colorectal cancer

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17
Q

What skin conditions can arise due to UC?

A

erythema nodosum
pyoderma gangrenosum

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18
Q

What other areas of the body can UC effect?

A

joints -ankylosing spondylitis
eyes - uveitis
liver - fatty change

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19
Q

What would blood tests show in UC?

A

raised WC
raised platelets
raised ESR and CRP

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20
Q

What would stool samples show in UC?

A

raised faecal calprotectin
rules out C. diff

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21
Q

What is the gold standard investigation for UC?

A

colonoscopy - biopsy
sigmoidoscopy

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22
Q

What is the type of medication used in UC?

A

aminosalicylates
(5- aminosalicyclic acid, 5-ASA)
oral or suppository (for proctitis)

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23
Q

Give an example of an aminosalicylate used to treat UC

A

sulfasalazine
mesalazine
olsalazine

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24
Q

What is the 2nd line treatment for UC?

A

corticosteroid - oral prednisone (glucocorticoid)

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25
Q

What surgical treatment can be used for UC?

A

colectomy
OR ileostomy + stoma

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26
Q

What part of the GI tract does Crohns disease effect?

A

any part from the mouth to the anus

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27
Q

What layers of bowel does Crohns effect?

A

transmural - through all layers of bowel
non - continuous, skip lesions

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28
Q

What are the key presentations of Crohns disease?

A

abdo pain
weight loss
bloody diarrhoea
pain on defecation

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29
Q

What are some of the extraintestinal signs of crohns?

A

clubbing
oral aphthous ulcers
skin/joint/eye problems

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30
Q

What are some of the complications of crohns disease?

A

malabsorption
perforation and obstruction
colorectal cancer
anaemia

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31
Q

What would blood tests show in crohns disease?

A

raised WCC, platelets, CRP and ESR
anaemia

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32
Q

Why might you do faecal tests if you suspect crohns disease?

A

to excludeC. diff/campylobacter
raised faecal calprotectin

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33
Q

What is the gold standard investigation for crohns disease?

A

colonoscopy/biopsy

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34
Q

What is the first line treatment for Crohns disease?

A

oral prednisolone
correct deficiencies - iron/folate/b12

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35
Q

Give an example of an anti-TNF antibody used to treat crohns

A

infliximab
adalimumab

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36
Q

What drug can help maintain remission in crohns disease?

A

azathioprine
methotrexate

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37
Q

What is irritable bowel syndrome?

A

a mixed group of abdominal symptoms with no organic cause

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38
Q

What are the key presentations of IBS?

A

ABC
Abdominal pain/discomfort
Bloating
Change in bowel habit

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39
Q

What are the diagnosis criteria for IBS?

A

abdominal pain/discomfort
+2 of:
relived by defecation
altered stool form
altered bowel frequency

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40
Q

What other symptoms may be associated with IBS?

A

painful periods
bladder symptoms
back pain
joint hypermobility
fatigue
nausea

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41
Q

What are some of the red flag symptoms for colon cancer?

A

unexplained weight loss
bleeding on defecation
abdo mass
anaemia
FH
age >50
nocturnal symptoms

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42
Q

What blood tests are used to rule out other diseases if IBS is suspected?

A

FBC - anaemia
ESR/CRP - inflammation
tTG/EMA - coeliac

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43
Q

What other investigations can be done to rule out differentials in IBS?

A

faecal calprotectin - IBD
colonoscopy - IBD, cancer

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44
Q

What is the management for mild IBS?

A

education and reassurance
dietary modification - regular meals, smaller meals, hydration, avoid caffeine/carbonated drinks
avoid FODMAPs - sugars found in fruits/veg

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45
Q

What can be recommended to patients with IBS-C (constipation)

A

eat barley/oats/beans/prunes/figs
soluble fibre

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46
Q

What can be recommended to patients with IBS-D (diarrhoea)

A

avoid insoluble fibre
cereals, whole wheat bread, lentils, apples, avocados

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47
Q

What medications can be given for pain/bloating in IBS?

A

antispasmodics e.g. mebeverine, buscopan

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48
Q

What medication can be given for diarrhoea in IBS?

A

loperamide

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49
Q

What medication can be given for constipation in IBS?

A

laxatives e.g. macrogol, docusate, senna

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50
Q

What can cause obstruction of the appendix leading to appendicitis?

A

faecoliths, bezoars, trauma, intestinal worms

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51
Q

What are the key presentations of appendicits?

A

guarding - tender mass in RIF
pyrexia - high temp (fever)
nausea/vomiting

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52
Q

What is the gold standard investigation for appendicitis?

A

CT scan

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53
Q

What is the gold standard treatment for acute appendicitis?

A

appendicectomy - laparoscopic
open (laparotomy) surgery is sometimes required

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54
Q

What should be given IV pre and post operatively in acute appendicitis?

A

abx e.g. metronidazole, cefuroxime

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55
Q

What are the complications of acute appendicitis?

A

perforation
adhesions
pelvic inflammatory disease

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56
Q

What can cause a small bowel obstruction?

A

adhesions - 60%
hernias
malignancy
crohns

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57
Q

What are the key presentations of small bowel obstruction

A

colicky pain ->diffuse pain
vomiting following pain
tenderness
increased bowel sounds (tinkling)

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58
Q

What is the 1st line investigation for small bowel obstruction?

A

abdominal X-ray
shows central gas shadows
no gas in large bowel
distension

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59
Q

What is the gold standard investigation for small bowel obstruction?

A

non-contrast CT
localises obstruction

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60
Q

How do you manage small bowel obstruction?

A

fluid resus
decompression of bowel “drip and suck”
nil-by-mouth start and NG tube, decompress bowel (suck)
IV fluids (drip)
analgesia
surgery to remove obstruction

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61
Q

What are the causes of large bowel obstruction ?

A

malignancy - 90%
volvulus - twisting of bowel (sigmoid colon most commonly)

62
Q

What are the key presentations of large bowel obstruction?

A

abdo pain
more abdo distension than SBO
vomiting occurs much later than in SBO
constipation earlier than SBO

63
Q

What is the first line investigation for large bowel obstructio?

A

abdominal X-ray
gas shadows proximal to blockage
caecum and ascending colon will be distended

64
Q

What is the gold standard investigation for large bowel obstruction?

A

CT scan

65
Q

What is the management for large bowel obstruction?

A

same as SBO
nil-by-mouth
NG tube, IV fluids (drip and suck)
abx, analgesia
surgery

66
Q

What are the causes of pseudo-bowel obstructions?

A

intra-abdo trauma
paralytic ileus (post op states)
intra-abdo sepsis
drugs e.g. opiates
electrolyte imbalance

67
Q

How does pseudo-bowel obstruction present?

A

the same as SBO and LBO

68
Q

What is the treatment for pseudo-bowel obstruction?

A

treat the underlying cause

69
Q

What are bacterial causes of diarrhoea?

A

campylobacter jejuni
E. coli
salmonella
shigella

70
Q

What are viral causes of diarrhoea (majority)?

A

children - rotavirus
adults - norovirus

71
Q

What are examples of parasitic causes of diarrhoea?

A

Giardia lamblia
entamoeba histolytica
cryptosporidium

72
Q

How long does diarrhoea present for to be classed as chronic?

A

2 weeks

73
Q

What is the management for diarrhoea?

A

treat the underlying cause
oral rehydration therapy (if severe)
loperamide
anti-emetics (metoclopramide)

74
Q

What are the 3 types of ischaemic bowel disease?

A

acute mesenteric
chronic mesenteric
ischaemic colitis (large bowel)

75
Q

What areas of the bowel are most susceptible to ischaemia?

A

splenic flexure and caecum

76
Q

What are some of the causes of acute mesenteric ischaemia?

A

superior mesenteric artery (SMA) thrombosis
SMA embolism

77
Q

What is the classical triad of symptoms associated with acute mesenteric ischaemia?

A

acute severe abdo pain
no abdo signs on exam
rapid hypovolaemia
(severe abdo pain with AF ->AMI)

78
Q

What imaging investigations can be used for acute mesenteric ischaemia?

A

abdo X ray - rule out bowel obstruction
CT/MRI angiography - look for arterial blockages

79
Q

How do you manage acute mesenteric ischaemia?

A

fluid resus
IV heparin to reduce clotting
abx - metronidazole, gentamicin
surgery to remove necrotic bowel

80
Q

What are the complications of acute mesenteric ischaemia?

A

sepsis, peritonitis

81
Q

What are some of the causes of ischaemic colitis?

A

thrombosis, emboli, low flow states, surgery, coagulation disorders

82
Q

What are the key presentations of ischaemic colitis?

A

sudden onset LIF pain
signs of hypovolaemic shock

83
Q

What imaging is done to rule out perforation wen ischaemic colitis is suspected?

A

Ct scan

84
Q

What investigation can be done AFTER ischaemic colitis recovery to confirm the diagnosis?

A

colonoscopy w/biopsy
rules out strictures, biopsy confirms mucosal healing

85
Q

What is the management for ischaemic colitis?

A

most patients will be fine with only symptomatic treatment
fluid replacement
abx
look out for strictures at disease site

86
Q

What are the symptoms of GORD?

A

heart burn
acid regurgitation
bloating
nocturnal cough
horse voice

87
Q

What are signs of a GI bleed?

A

malaena
coffee ground vomiting

88
Q

What red flag symptoms may mean GI cancer?

A

dysphagia
age >55
abdo pain
resistant dyspepsia
weight loss
vomiting
low Hb
high platelets

89
Q

What lifestyle advice would you give to someone with GORD?

A

drink less coffee/alcohol
avoid smoking
smaller meals
weight loss
stay upright after a meal

90
Q

What acid neutralising medications are used to treat GORD?

A

gaviscon
Rennie

91
Q

What proton pump inhibitors are used to treat GORD?

A

omeprazole
lansoprazole

92
Q

What medication, which is a H2 receptor antagonist (antihistamine), can be used instead of PPIs?

A

ranitidine

93
Q

What surgical procedure can be used to treat GORD?

A

laparoscopic fundoplication

94
Q

What type of bacteria is H. pylori?

A

gram negative aerobic bacteria

95
Q

Where does H. pylori invade to protect itself from stomach acid?

A

gastric mucosa

96
Q

What is secreted by H. pylori and damages epithelial cells in the stomach?

A

ammonia

97
Q

What tests are done to test for H. pylorI?

A

urea breath test (carbon 13)
stool antigen test
rapid urease test

98
Q

How is the rapid urease test done?

A

performed during endoscopy, sample of mucosa taken and urea added, H. pylori will convert this into ammonia - higher pH

99
Q

What treatment, called the eradication regime is used to treat H.pylori infection?

A

triple therapy with:
PPI - omeprazole
2 abx - amoxicillin and clarithromycin

100
Q

What is the main risk of Barretts oesophagus?

A

it is premalignant so could form an adenocarcinoma

101
Q

What medication is used to treat Barrett’s oesophagus?

A

omeprazole

102
Q

How are patients with Barrett’s oesophagus monitored for adenocarcinoma?

A

regular endoscopy

103
Q

What are the methods for ablation treatment in GORD?

A

laser/cryo/photodynamic therapy - destroys epithelium so that it can be replaced by normal cells

104
Q

What are the most common causes of peptic ulcers?

A

drugs - steroids or NSAIDs
H. pylori

105
Q

What lifestyle/diet factors can increase stomach acids?

A

stress
alcohol
smoking
caffeine
spicy foods

106
Q

How are peptic ulcers diagnoses?

A

with endoscopy

107
Q

How are peptic ulcers treated?

A

same as GORD
high does PPI (omeprazole)

108
Q

Name some of the complications of peptic ulcers

A

bleeding
perforation - acute abdomen and peritonitis
scarring/strictures - pyloric stenosis

109
Q

What is a diverticulum?

A

a pouch in the bowel wall

110
Q

What is diverticulitis?

A

infection and inflammation of diverticula

111
Q

What is diverticulosis?

A

wear and tear of the bowel, commonly in the sigmoid colon

112
Q

What are risk factors for diverticulosis?

A

increased age
low fibre diets
obesity
NSAID use

113
Q

How would you treat symptomatic diverticulosis?

A

increased fibre in diet
bulk-forming laxatives (ispaghula husk)

114
Q

What symptoms may occur from diverticulosis?

A

abdo pain
constipation
rectal bleeding

115
Q

What does acute diverticulitis present with?

A

fever
diarrhoea
nausea/vomiting
rectal bleeding
palpable mass
raised inflammatory markers

116
Q

What is the treatment for acute diverticulitis?

A

co-amoxiclav
analgesia (not NSAIDs or opiates)
clear liquids only (avoid solid food)

117
Q

What are the most common agents to cause viral gastroeneteritis?

A

norovirus
rotavirus
adenovirus (less common)

118
Q

What type of bacteria is bacillus cereus?

A

gram positive rod

119
Q

What are the general treatments for gastroenteritis?

A

isolation
good hygiene
hydration
introduce small meals

120
Q

Give an example of an antidiarrhoeal

A

loperamide

121
Q

Give an example of an antiemetic

A

metoclopromatide

122
Q

What are the causes of an upper GI bleed?

A

oesophageal varices
mallory Weiss tear
gastric/duodenal ulcers
cancers of the stomach

123
Q

What are the presentations of an upper GI bleed?

A

haematemesis (vomiting blood)
coffee ground vomit
malaena
signs of cause:
abdo pain
dyspepsia
jaundice

124
Q

What score is used to establish the risk of a GI bleed?

A

Glasgow-Blatchford score

125
Q

Why is urea high in GI bleed?

A

blood is broken down by gastric acid into urea and is absorbed

126
Q

What score is used to assess the risk of rebleeding/death in patients who have had an endoscopy?

A

Rockall score

127
Q

What is the management for upper GI bleed?
(ABATED)

A

ABCDE
Bloods
Access (cannula)
Transfuse
Endoscopy
Drugs (stop anticoags/NSAIDs)

128
Q

What blood might you do for patients with GI bleeds?

A

FBC - Hb
U&Es - urea
INR - coag
LFTs
Crossmatch (transfusions)

129
Q

What additional treatments should be used for oesophageal varices?

A

Terlipressin
prophylactic broad spectrum abx

130
Q

What are the key presentations of oesophageal cancer?

A

dysphagia
retrosternal pain
weight loss
odynophagia (painful swallowing)

131
Q

What is the main diagnostic tool for oesophageal cancer?

A

endoscopy + biopsy

132
Q

What are the surgical treatments for oesophageal cancer?

A

oesophagectomy

133
Q

What chemo is used for oesophageal cancer?

A

nivolumab

134
Q

What type of bacteria is C. diff

A

gram negative anaerobic

135
Q

what is the test for C. Diff?

A

stool culture

136
Q

What is the first line treatment for C. diff?

A

vancomycin

137
Q

What is achalasia?

A

oesophageal motor neuron disorder

138
Q

What medications can be used to treat achalasia?

A

CCBs/nitrates

139
Q

what is a common presentation of haemorrhoids?

A

painless, bright red bleeding

140
Q

What might be required for proper examination of haemorhoids?

A

proctoscopy - insertion of a hollow tube into the anal cavity to see the mucosa

141
Q

What topical treatments can be used to treat haemorrhoids?

A

anusol (shrinks haemorrhoids)
germoloids cream (local anaesthetic)

142
Q

What preventitive measures are there for haemorrhoids?

A

increase fibre in diet
stay hydrated
use laxatives when required
avoid straining

143
Q

What are the key presentations of an anal fissure?

A

pain on defecation
rectal bleeding
visible fissure on exam

144
Q

What is the management for an anal fissure?

A

topical GTN/CCB

145
Q

What are the key presentations of an anal fistula?

A

pain and swelling of the anus

146
Q

What is the treatment for an anal fistula?

A

fistulotomy and excision

147
Q

What is a perianal abscess?

A

infection of the soft tissue around the anus

148
Q

What are the key presentations of a perianal abscess?

A

perianal pain
erythema
leukocytosis

149
Q

What is the first line care for a perianal abscess?

A

incision and drainage

150
Q

What is a pilonidal abscess?

A

a hole in the skin formed by forceful insertion of hairs into the skin

151
Q

What are the key presentations of a pilonidal abscess?

A

discharge
pain
swelling
sinus tracts at the site of abscess

medicine phase 2 a (10 decks)

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