GI Flashcards
1
Q
What hypersensitivity is coeliac disease?
A
type 4 - t cell mediated
2
Q
What type of protein is not tolerated in coeliac disease?
A
prolamin (a-gliadin)
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
4
Q
What physiological change happens in the gut to cause symptoms of coeliac disease?
A
villous atrophy and crypt hyperplasia
5
Q
What are the key presentations of coeliac disease?
A
malabsorption - weight loss
steatorrhea
anaemia (B12 deficiency)
fatigue
diarrhoea
abdominal pain
6
Q
What can decreased vitamin D lead to in coeliac disease?
A
osteomalacia
7
Q
What are the main complications of coeliac disease?
A
anaemia
malignancy - T cell lymphoma, GI cancers
8
Q
What is the 1st line investigation for coeliac disease?
A
IgA tissue transglutaminase (TTG)
9
Q
What is the gold standard investigation for coeliac disease?
A
duodenal biopsy
10
Q
What would an FBC show in someone with coeliac disease?
A
low Hb
low folate
low ferritin
low B12
11
Q
What areas of the bowel does ulcerative colitis (UC) effect?
A
ONLY the colon
starts at rectum - can progress to ileocaecal valve
12
Q
What layer of the bowel does UC effect?
A
ONLY the mucosa but is circumferential and continuous
13
Q
What may be present in severe UC?
A
ulcers and pseudo-polyps
14
Q
What is a protective factor against UC?
A
smoking
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
16
Q
What are the colon related complications of UC?
A
blood loss
perforation
toxic dilation
colorectal cancer
17
Q
What skin conditions can arise due to UC?
A
erythema nodosum
pyoderma gangrenosum
18
Q
What other areas of the body can UC effect?
A
joints -ankylosing spondylitis
eyes - uveitis
liver - fatty change
19
Q
What would blood tests show in UC?
A
raised WC
raised platelets
raised ESR and CRP
20
Q
What would stool samples show in UC?
A
raised faecal calprotectin
rules out C. diff
21
Q
What is the gold standard investigation for UC?
A
colonoscopy - biopsy
sigmoidoscopy
22
Q
What is the type of medication used in UC?
A
aminosalicylates
(5- aminosalicyclic acid, 5-ASA)
oral or suppository (for proctitis)
23
Q
Give an example of an aminosalicylate used to treat UC
A
sulfasalazine
mesalazine
olsalazine
24
Q
What is the 2nd line treatment for UC?
A
corticosteroid - oral prednisone (glucocorticoid)
25
What surgical treatment can be used for UC?
colectomy
OR ileostomy + stoma
26
What part of the GI tract does Crohns disease effect?
any part from the mouth to the anus
27
What layers of bowel does Crohns effect?
transmural - through all layers of bowel
non - continuous, skip lesions
28
What are the key presentations of Crohns disease?
abdo pain
weight loss
bloody diarrhoea
pain on defecation
29
What are some of the extraintestinal signs of crohns?
clubbing
oral aphthous ulcers
skin/joint/eye problems
30
What are some of the complications of crohns disease?
malabsorption
perforation and obstruction
colorectal cancer
anaemia
31
What would blood tests show in crohns disease?
raised WCC, platelets, CRP and ESR
anaemia
32
Why might you do faecal tests if you suspect crohns disease?
to excludeC. diff/campylobacter
raised faecal calprotectin
33
What is the gold standard investigation for crohns disease?
colonoscopy/biopsy
34
What is the first line treatment for Crohns disease?
oral prednisolone
correct deficiencies - iron/folate/b12
35
Give an example of an anti-TNF antibody used to treat crohns
infliximab
adalimumab
36
What drug can help maintain remission in crohns disease?
azathioprine
methotrexate
37
What is irritable bowel syndrome?
a mixed group of abdominal symptoms with no organic cause
38
What are the key presentations of IBS?
ABC
Abdominal pain/discomfort
Bloating
Change in bowel habit
39
What are the diagnosis criteria for IBS?
abdominal pain/discomfort
+2 of:
relived by defecation
altered stool form
altered bowel frequency
40
What other symptoms may be associated with IBS?
painful periods
bladder symptoms
back pain
joint hypermobility
fatigue
nausea
41
What are some of the red flag symptoms for colon cancer?
unexplained weight loss
bleeding on defecation
abdo mass
anaemia
FH
age >50
nocturnal symptoms
42
What blood tests are used to rule out other diseases if IBS is suspected?
FBC - anaemia
ESR/CRP - inflammation
tTG/EMA - coeliac
43
What other investigations can be done to rule out differentials in IBS?
faecal calprotectin - IBD
colonoscopy - IBD, cancer
44
What is the management for mild IBS?
education and reassurance
dietary modification - regular meals, smaller meals, hydration, avoid caffeine/carbonated drinks
avoid FODMAPs - sugars found in fruits/veg
45
What can be recommended to patients with IBS-C (constipation)
eat barley/oats/beans/prunes/figs
soluble fibre
46
What can be recommended to patients with IBS-D (diarrhoea)
avoid insoluble fibre
cereals, whole wheat bread, lentils, apples, avocados
47
What medications can be given for pain/bloating in IBS?
antispasmodics e.g. mebeverine, buscopan
48
What medication can be given for diarrhoea in IBS?
loperamide
49
What medication can be given for constipation in IBS?
laxatives e.g. macrogol, docusate, senna
50
What can cause obstruction of the appendix leading to appendicitis?
faecoliths, bezoars, trauma, intestinal worms
51
What are the key presentations of appendicits?
guarding - tender mass in RIF
pyrexia - high temp (fever)
nausea/vomiting
52
What is the gold standard investigation for appendicitis?
CT scan
53
What is the gold standard treatment for acute appendicitis?
appendicectomy - laparoscopic
open (laparotomy) surgery is sometimes required
54
What should be given IV pre and post operatively in acute appendicitis?
abx e.g. metronidazole, cefuroxime
55
What are the complications of acute appendicitis?
perforation
adhesions
pelvic inflammatory disease
56
What can cause a small bowel obstruction?
adhesions - 60%
hernias
malignancy
crohns
57
What are the key presentations of small bowel obstruction
colicky pain ->diffuse pain
vomiting following pain
tenderness
increased bowel sounds (tinkling)
58
What is the 1st line investigation for small bowel obstruction?
abdominal X-ray
shows central gas shadows
no gas in large bowel
distension
59
What is the gold standard investigation for small bowel obstruction?
non-contrast CT
localises obstruction
60
How do you manage small bowel obstruction?
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
61
What are the causes of large bowel obstruction ?
malignancy - 90%
volvulus - twisting of bowel (sigmoid colon most commonly)
62
What are the key presentations of large bowel obstruction?
abdo pain
more abdo distension than SBO
vomiting occurs much later than in SBO
constipation earlier than SBO
63
What is the first line investigation for large bowel obstructio?
abdominal X-ray
gas shadows proximal to blockage
caecum and ascending colon will be distended
64
What is the gold standard investigation for large bowel obstruction?
CT scan
65
What is the management for large bowel obstruction?
same as SBO
nil-by-mouth
NG tube, IV fluids (drip and suck)
abx, analgesia
surgery
66
What are the causes of pseudo-bowel obstructions?
intra-abdo trauma
paralytic ileus (post op states)
intra-abdo sepsis
drugs e.g. opiates
electrolyte imbalance
67
How does pseudo-bowel obstruction present?
the same as SBO and LBO
68
What is the treatment for pseudo-bowel obstruction?
treat the underlying cause
69
What are bacterial causes of diarrhoea?
campylobacter jejuni
E. coli
salmonella
shigella
70
What are viral causes of diarrhoea (majority)?
children - rotavirus
adults - norovirus
71
What are examples of parasitic causes of diarrhoea?
Giardia lamblia
entamoeba histolytica
cryptosporidium
72
How long does diarrhoea present for to be classed as chronic?
2 weeks
73
What is the management for diarrhoea?
treat the underlying cause
oral rehydration therapy (if severe)
loperamide
anti-emetics (metoclopramide)
74
What are the 3 types of ischaemic bowel disease?
acute mesenteric
chronic mesenteric
ischaemic colitis (large bowel)
75
What areas of the bowel are most susceptible to ischaemia?
splenic flexure and caecum
76
What are some of the causes of acute mesenteric ischaemia?
superior mesenteric artery (SMA) thrombosis
SMA embolism
77
What is the classical triad of symptoms associated with acute mesenteric ischaemia?
acute severe abdo pain
no abdo signs on exam
rapid hypovolaemia
(severe abdo pain with AF ->AMI)
78
What imaging investigations can be used for acute mesenteric ischaemia?
abdo X ray - rule out bowel obstruction
CT/MRI angiography - look for arterial blockages
79
How do you manage acute mesenteric ischaemia?
fluid resus
IV heparin to reduce clotting
abx - metronidazole, gentamicin
surgery to remove necrotic bowel
80
What are the complications of acute mesenteric ischaemia?
sepsis, peritonitis
81
What are some of the causes of ischaemic colitis?
thrombosis, emboli, low flow states, surgery, coagulation disorders
82
What are the key presentations of ischaemic colitis?
sudden onset LIF pain
signs of hypovolaemic shock
83
What imaging is done to rule out perforation wen ischaemic colitis is suspected?
Ct scan
84
What investigation can be done AFTER ischaemic colitis recovery to confirm the diagnosis?
colonoscopy w/biopsy
rules out strictures, biopsy confirms mucosal healing
85
What is the management for ischaemic colitis?
most patients will be fine with only symptomatic treatment
fluid replacement
abx
look out for strictures at disease site
86
What are the symptoms of GORD?
heart burn
acid regurgitation
bloating
nocturnal cough
horse voice
87
What are signs of a GI bleed?
malaena
coffee ground vomiting
88
What red flag symptoms may mean GI cancer?
dysphagia
age >55
abdo pain
resistant dyspepsia
weight loss
vomiting
low Hb
high platelets
89
What lifestyle advice would you give to someone with GORD?
drink less coffee/alcohol
avoid smoking
smaller meals
weight loss
stay upright after a meal
90
What acid neutralising medications are used to treat GORD?
gaviscon
Rennie
91
What proton pump inhibitors are used to treat GORD?
omeprazole
lansoprazole
92
What medication, which is a H2 receptor antagonist (antihistamine), can be used instead of PPIs?
ranitidine
93
What surgical procedure can be used to treat GORD?
laparoscopic fundoplication
94
What type of bacteria is H. pylori?
gram negative aerobic bacteria
95
Where does H. pylori invade to protect itself from stomach acid?
gastric mucosa
96
What is secreted by H. pylori and damages epithelial cells in the stomach?
ammonia
97
What tests are done to test for H. pylorI?
urea breath test (carbon 13)
stool antigen test
rapid urease test
98
How is the rapid urease test done?
performed during endoscopy, sample of mucosa taken and urea added, H. pylori will convert this into ammonia - higher pH
99
What treatment, called the eradication regime is used to treat H.pylori infection?
triple therapy with:
PPI - omeprazole
2 abx - amoxicillin and clarithromycin
100
What is the main risk of Barretts oesophagus?
it is premalignant so could form an adenocarcinoma
101
What medication is used to treat Barrett's oesophagus?
omeprazole
102
How are patients with Barrett's oesophagus monitored for adenocarcinoma?
regular endoscopy
103
What are the methods for ablation treatment in GORD?
laser/cryo/photodynamic therapy - destroys epithelium so that it can be replaced by normal cells
104
What are the most common causes of peptic ulcers?
drugs - steroids or NSAIDs
H. pylori
105
What lifestyle/diet factors can increase stomach acids?
stress
alcohol
smoking
caffeine
spicy foods
106
How are peptic ulcers diagnoses?
with endoscopy
107
How are peptic ulcers treated?
same as GORD
high does PPI (omeprazole)
108
Name some of the complications of peptic ulcers
bleeding
perforation - acute abdomen and peritonitis
scarring/strictures - pyloric stenosis
109
What is a diverticulum?
a pouch in the bowel wall
110
What is diverticulitis?
infection and inflammation of diverticula
111
What is diverticulosis?
wear and tear of the bowel, commonly in the sigmoid colon
112
What are risk factors for diverticulosis?
increased age
low fibre diets
obesity
NSAID use
113
How would you treat symptomatic diverticulosis?
increased fibre in diet
bulk-forming laxatives (ispaghula husk)
114
What symptoms may occur from diverticulosis?
abdo pain
constipation
rectal bleeding
115
What does acute diverticulitis present with?
fever
diarrhoea
nausea/vomiting
rectal bleeding
palpable mass
raised inflammatory markers
116
What is the treatment for acute diverticulitis?
co-amoxiclav
analgesia (not NSAIDs or opiates)
clear liquids only (avoid solid food)
117
What are the most common agents to cause viral gastroeneteritis?
norovirus
rotavirus
adenovirus (less common)
118
What type of bacteria is bacillus cereus?
gram positive rod
119
What are the general treatments for gastroenteritis?
isolation
good hygiene
hydration
introduce small meals
120
Give an example of an antidiarrhoeal
loperamide
121
Give an example of an antiemetic
metoclopromatide
122
What are the causes of an upper GI bleed?
oesophageal varices
mallory Weiss tear
gastric/duodenal ulcers
cancers of the stomach
123
What are the presentations of an upper GI bleed?
haematemesis (vomiting blood)
coffee ground vomit
malaena
signs of cause:
abdo pain
dyspepsia
jaundice
124
What score is used to establish the risk of a GI bleed?
Glasgow-Blatchford score
125
Why is urea high in GI bleed?
blood is broken down by gastric acid into urea and is absorbed
126
What score is used to assess the risk of rebleeding/death in patients who have had an endoscopy?
Rockall score
127
What is the management for upper GI bleed?
(ABATED)
ABCDE
Bloods
Access (cannula)
Transfuse
Endoscopy
Drugs (stop anticoags/NSAIDs)
128
What blood might you do for patients with GI bleeds?
FBC - Hb
U&Es - urea
INR - coag
LFTs
Crossmatch (transfusions)
129
What additional treatments should be used for oesophageal varices?
Terlipressin
prophylactic broad spectrum abx
130
What are the key presentations of oesophageal cancer?
dysphagia
retrosternal pain
weight loss
odynophagia (painful swallowing)
131
What is the main diagnostic tool for oesophageal cancer?
endoscopy + biopsy
132
What are the surgical treatments for oesophageal cancer?
oesophagectomy
133
What chemo is used for oesophageal cancer?
nivolumab
134
What type of bacteria is C. diff
gram negative anaerobic
135
what is the test for C. Diff?
stool culture
136
What is the first line treatment for C. diff?
vancomycin
137
What is achalasia?
oesophageal motor neuron disorder
138
What medications can be used to treat achalasia?
CCBs/nitrates
139
what is a common presentation of haemorrhoids?
painless, bright red bleeding
140
What might be required for proper examination of haemorhoids?
proctoscopy - insertion of a hollow tube into the anal cavity to see the mucosa
141
What topical treatments can be used to treat haemorrhoids?
anusol (shrinks haemorrhoids)
germoloids cream (local anaesthetic)
142
What preventitive measures are there for haemorrhoids?
increase fibre in diet
stay hydrated
use laxatives when required
avoid straining
143
What are the key presentations of an anal fissure?
pain on defecation
rectal bleeding
visible fissure on exam
144
What is the management for an anal fissure?
topical GTN/CCB
145
What are the key presentations of an anal fistula?
pain and swelling of the anus
146
What is the treatment for an anal fistula?
fistulotomy and excision
147
What is a perianal abscess?
infection of the soft tissue around the anus
148
What are the key presentations of a perianal abscess?
perianal pain
erythema
leukocytosis
149
What is the first line care for a perianal abscess?
incision and drainage
150
What is a pilonidal abscess?
a hole in the skin formed by forceful insertion of hairs into the skin
151
What are the key presentations of a pilonidal abscess?
discharge
pain
swelling
sinus tracts at the site of abscess
