GI Flashcards
describe what would be seen on colonoscopy and biopsy for someone with Crohn’s disease
GALS:
- Granuloma
- All
- Layers and levels - transmural, mouth to anus
- Skip lesions
also
- deep ulcers and fissures: “cobblestone mucosa”
- goblet cells present
what is the first line investigation for Coeliac disease?
IgA tissue transglutaminase or IgA endomysial antibody (anti-tTGA or EMA)
coughing in oesophageal cancer indicates the mass is where?
upper third of oesophagus
describe the metaplasia in Barrett’s oesophagus
distal oesophageal epithelium metaplases from squamous to columnar
what is the first line treatment for a peptic ulcer?
PPI + amoxicillin + clarithromycin / metronidazole
which cells do PPIs act on?
parietal cells
name 5 types of diarrhoea
inflammatory, secretory, osmotic, exudative, dysentery
What symptoms or history points would lead you to think of inflammatory diarrhoea?
- painful abdomen
- severe diarrhoea (watery)
- fever
- tenesmus
What clinical tool would you use to classify faeces?
bristol stool chart
List 4 symptoms of small bowel obstruction
- abdominal distension
- abdominal pain
- nausea / vomiting
- constipation
What would your initial supportive management be in small bowel obstruction?
‘Drip and suck’ management:
- Make the patient nil-by-mouth (NBM)
- Insert a nasogastric tube to decompress the bowel (‘suck’)
- Start IV fluids and correct any electrolyte disturbances (‘drip’)
- Urinary catheter and fluid balance
- Analgesia as required
- suitable anti-emetics
what complication of SBO would lead to emergency surgery?
bowel ischaemia or strangulation
4 causes of gastritis?
- autoimmune
- NSAIDs
- alcohol abuse
- bile reflux
- mucosal ischaemia
What investigations would you use if you suspect an infective cause of gastritis?
urea breath test, faecal antigen test
differentials for gastritis?
peptic ulcer, GORD, gastric lymphoma/carcinoma
Name 4 clinical features of haemorrhoids
bright red blood in stools, pain on defecation, pruritis ani, mucus discharge
Briefly describe the pathophysiology of haemorrhoids
swelling and inflammation of veins in rectum and anus
Describe the two types of haemorrhoids
Internal haemorrhoids:
- arise internally
- are painless covered in mucus
- can also prolapse
External haemorrhoids
- Form at the anal opening
- painful
- covered with skin.
Give 5 non-surgical and 3 surgical treatment of haemorrhoids
Non-surgical:
- Stool softeners
- High fibre diet
- adequate fluid intake
- Analgesia
- Topical hydrocortisone.
Surgical:
- Band ligation
- haemorrhoidectomy
- Sclerotherapy (shrinking veins till absorbed by body)
symptoms of IBS?
- abdominal pain or discomfort that is either relieved by defecation or associated with altered bowel frequency or stool form
- altered stool passage
- Abdominal bloating (more common in women than men), distension, tension or hardness
- Symptoms made worse by eating
- Passage of mucus
List 5 causes of acute diarrhoea
- Antibiotic associated diarrhoea - eg cephalosporins / clindamycin associated with C. difficile infections
- Parasitic cause (e.g. Giardia Lamblia)
- Bacterial cause (e.g. Salmonella from food poisoning / Campylobacter infection from puppies in small children
- Viral cause (e.g. Rotavirus - affects nearly all kids by age 4 / Norovirus - associated with cruise ships
- Drugs eg allopurinol / NSAIDs / PPIs etc
- Constipation with ‘overflow’ diarrhoea
- Anxiety
- Food allergy
- Early sign of a chronic condition such as IBS / IBD
Name 2 non-invasive tests for H.pylori infection
- C-urea /13C breath test (1st line)
- Blood/serological testing / IgG antibody detection
- Stool antigen test
list 4 complications of diverticulitis
- Large bowel perforation / obstruction
- Fistula formation
- Bleeding
- Mucosal inflammation (Can mimic Crohn’s disease on endoscopy)
List 5 risk factors for oesophageal cancer
Alcohol, Smoking tobacco, Obesity, GORD, Achalasia
What is the first line drug used to treat haematemesis from ruptured oesophageal varices and what should be used if contraindicated?
- IV Terlipressin acts as a vasodilator to control variceal bleeding.
- If contraindicated (e.g. in IHD) -> IV somatostatin
gold standard exam for appendicitis?
CT
5 differentials of appendicitis?
- Crohn’s disease (causing acute terminal ileitis)
- Ectopic pregnancy
- UTI - urinalysis
- Diverticulitis
- Perforated ulcer
- Food poisoning
give a brief history of H. Pylori gastritis
worsening epigastric pain, weight loss, no vomiting or diarrhoea, active inflammation on endoscopy/biopsy
describe the differences between SBO and LBO?
SBO
- acute
- mid abdo pain, colicky to constant pain
- early vomiting, may present with constipation
- mild - moderate distension
LBO
- gradual
- lower abdo pain, continuous pain
- late stage vomiting, marked constipation
- severe distension
which condition is associated with ulcerative colitis?
primary sclerosing cholangitis
which antibiotics commonly cause C. difficile toxin?
clindamycin, cephalosporins, quinolones, co-amoxiclav and aminopenicillins
second line investigation for coeliac after blood tests (also is gold standard?)
endoscopy with duodenal biopsy
what is the name of the bowel caner screening home-test kit?
faecal immunochemical test
where in the GI tract do Mallory-Weiss tears occur?
gastro-oesophageal junction
What is the gold standard investigation for diagnosing acute diverticulitis?
contrast CT colonography
What is the commonest cause of oesophageal varices in the UK?
liver cirrhosis
what is the most likely cause of intestinal obstruction following surgery?
intra-abdominal adhesions
what kind of anaemia can colorectal cancer cause?
iron deficiency anaemia
are crypt abcesses seen in UC or CD?
UC
what is diverticulosis?
- condition occurs when small pouches/sacs form and push outward through weak spots in the wall of colon
- can be asymptomatic and can lead to diverticulitis
what supplements will be needed after ileo-caecal resection?
vit B12
where are colorectal cancers most commonly found?
rectum
What is a potential complication of a Mallory-Weiss tear?
Substantial blood loss, shock, collapse, haemorrhage
what is the treatment for Mallory-Weiss tear?
Endoscopic haemostasis
Give 3 red flag signs for GORD complications
weight loss, haematemesis, dysphagia
Give 2 causes (not RF) of Gastro-Oesophageal Reflux Disease
- Lower oesophageal sphincter hypotension
- Hiatus hernia
- Abdominal obesity
- Gastric acid hypersecretion
- Slow gastric emptying
- Drugs e.g. Calcium Channel Blockers, Nitrates or Anti-muscarinic)
- Systemic Sclerosis
give 3 non-intestinal symptoms of IBS
painful period, change in urinary symptoms, back pain, fatigue
What is the name of the criteria used to diagnose Irritable Bowel Syndrome?
rome III diagnostic criteria
what class of drug can be given to relieve bloating and the associated pain of IBS?
antispasmodics / anticholinergics
what stimulates mucus secretion?
prostaglandins
what is first line medication management of a H. pylori infection causing gastritis?
clarithromycin, amoxicillin and omeprazole
what is the first line investigation for an abdo obstruction?
abdo XR
does UC have skip lesions?
no
name 4 causes of diverticulum
- low fibre diet
- obesity
- NSAIDs
- smoking
name 2 things seen on duodenal biopsy in Coeliac?
villous atrophy and crypt hyperplasia
what kind of anaemia is seen in Crohn’s disease?
iron and folate deficiency due to malabsorption
name 3 sites where you might see a hernia?
inguinal, femoral, umbilical, incisional
Other than to digest food give 3 functions of the stomach.
- Kill Microbes/Bacteria
- Secrete intrinsic factor / enable B12 absorption
- Store and/or Mix food
- Secrete and active proteases
- Produce stomach acid
- Regulate emptying into the duodenum
Define malabsorption.
Inadequate absorption of nutrients/food in/by the small intestines
Why do 95% of abdominal aneurysms occur below the renal arteries but above the aortic bifurcation?
naturally contain less elastin in the arterial wall
What area of Virchow’s triangle does an abdominal aortic aneurysm affect
stasis, abnormality in blood flow
What size must an AAA reach to be considered operable?
> 5.5cm2
State Laplace’s Law
R=1/r^4
what do most colon cancers develop from?
polyps
what proportion of colon cancers develop in the rectum?
1/3
what is the most common type of carcinoma found in colorectal cancer?
adenocarcinoma
What is the current bowel cancer screening programme?
faecal occult blood test in men/women aged 60-69
What 2 methods can be used to stage CRC?
TNM / duke’s staging
coeliac disease: what is the single most likely pathology to be seen on endoscopy?
villous atrophy
give 4 extraintestinal symptoms of UC
Arthritis
Conjunctivitis
Clubbing (more common in CD)
Pyoderma Gangrenosum
e.g. first line drug for diarrhoea in IBS?
loperamide - anti-motility agent
name 3 risk factors for CD
family history, HLA-B27, caucasian, smoking, NSAIDs
describe goblet cells in CD and UC
increased in CD, decreased in UC
Name two other primary investigations / blood markers you may use in the diagnostic process for Crohn’s disease.
- faecal calprotectin
- FBC: leukocytosis in a flare up
- CRP/ESR
- U&Es
- colonoscopy and biopsy
