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GI Flashcards

1
Q

describe what would be seen on colonoscopy and biopsy for someone with Crohn’s disease

A

GALS:
- Granuloma
- All
- Layers and levels - transmural, mouth to anus
- Skip lesions
also
- deep ulcers and fissures: “cobblestone mucosa”
- goblet cells present

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2
Q

what is the first line investigation for Coeliac disease?

A

IgA tissue transglutaminase or IgA endomysial antibody (anti-tTGA or EMA)

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3
Q

coughing in oesophageal cancer indicates the mass is where?

A

upper third of oesophagus

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4
Q

describe the metaplasia in Barrett’s oesophagus

A

distal oesophageal epithelium metaplases from squamous to columnar

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5
Q

what is the first line treatment for a peptic ulcer?

A

PPI + amoxicillin + clarithromycin / metronidazole

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6
Q

which cells do PPIs act on?

A

parietal cells

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7
Q

name 5 types of diarrhoea

A

inflammatory, secretory, osmotic, exudative, dysentery

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8
Q

What symptoms or history points would lead you to think of inflammatory diarrhoea?

A
  • painful abdomen
  • severe diarrhoea (watery)
  • fever
  • tenesmus
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9
Q

What clinical tool would you use to classify faeces?

A

bristol stool chart

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10
Q

List 4 symptoms of small bowel obstruction

A
  • abdominal distension
  • abdominal pain
  • nausea / vomiting
  • constipation
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11
Q

What would your initial supportive management be in small bowel obstruction?

A

‘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

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12
Q

what complication of SBO would lead to emergency surgery?

A

bowel ischaemia or strangulation

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13
Q

4 causes of gastritis?

A
  • autoimmune
  • NSAIDs
  • alcohol abuse
  • bile reflux
  • mucosal ischaemia
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14
Q

What investigations would you use if you suspect an infective cause of gastritis?

A

urea breath test, faecal antigen test

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15
Q

differentials for gastritis?

A

peptic ulcer, GORD, gastric lymphoma/carcinoma

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16
Q

Name 4 clinical features of haemorrhoids

A

bright red blood in stools, pain on defecation, pruritis ani, mucus discharge

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17
Q

Briefly describe the pathophysiology of haemorrhoids

A

swelling and inflammation of veins in rectum and anus

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18
Q

Describe the two types of haemorrhoids

A

Internal haemorrhoids:
- arise internally
- are painless covered in mucus
- can also prolapse
External haemorrhoids
- Form at the anal opening
- painful
- covered with skin.

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19
Q

Give 5 non-surgical and 3 surgical treatment of haemorrhoids

A

Non-surgical:
- Stool softeners
- High fibre diet
- adequate fluid intake
- Analgesia
- Topical hydrocortisone.
Surgical:
- Band ligation
- haemorrhoidectomy
- Sclerotherapy (shrinking veins till absorbed by body)

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20
Q

symptoms of IBS?

A
  • 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
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21
Q

List 5 causes of acute diarrhoea

A
  • 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
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22
Q

Name 2 non-invasive tests for H.pylori infection

A
  • C-urea /13C breath test (1st line)
  • Blood/serological testing / IgG antibody detection
  • Stool antigen test
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23
Q

list 4 complications of diverticulitis

A
  • Large bowel perforation / obstruction
  • Fistula formation
  • Bleeding
  • Mucosal inflammation (Can mimic Crohn’s disease on endoscopy)
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24
Q

List 5 risk factors for oesophageal cancer

A

Alcohol, Smoking tobacco, Obesity, GORD, Achalasia

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25
Q

What is the first line drug used to treat haematemesis from ruptured oesophageal varices and what should be used if contraindicated?

A
  • IV Terlipressin acts as a vasodilator to control variceal bleeding.
  • If contraindicated (e.g. in IHD) -> IV somatostatin
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26
Q

gold standard exam for appendicitis?

A

CT

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27
Q

5 differentials of appendicitis?

A
  • Crohn’s disease (causing acute terminal ileitis)
  • Ectopic pregnancy
  • UTI - urinalysis
  • Diverticulitis
  • Perforated ulcer
  • Food poisoning
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28
Q

give a brief history of H. Pylori gastritis

A

worsening epigastric pain, weight loss, no vomiting or diarrhoea, active inflammation on endoscopy/biopsy

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29
Q

describe the differences between SBO and LBO?

A

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

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30
Q

which condition is associated with ulcerative colitis?

A

primary sclerosing cholangitis

31
Q

which antibiotics commonly cause C. difficile toxin?

A

clindamycin, cephalosporins, quinolones, co-amoxiclav and aminopenicillins

32
Q

second line investigation for coeliac after blood tests (also is gold standard?)

A

endoscopy with duodenal biopsy

33
Q

what is the name of the bowel caner screening home-test kit?

A

faecal immunochemical test

34
Q

where in the GI tract do Mallory-Weiss tears occur?

A

gastro-oesophageal junction

35
Q

What is the gold standard investigation for diagnosing acute diverticulitis?

A

contrast CT colonography

36
Q

What is the commonest cause of oesophageal varices in the UK?

A

liver cirrhosis

37
Q

what is the most likely cause of intestinal obstruction following surgery?

A

intra-abdominal adhesions

38
Q

what kind of anaemia can colorectal cancer cause?

A

iron deficiency anaemia

39
Q

are crypt abcesses seen in UC or CD?

A

UC

40
Q

what is diverticulosis?

A
  • 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
41
Q

what supplements will be needed after ileo-caecal resection?

A

vit B12

42
Q

where are colorectal cancers most commonly found?

A

rectum

43
Q

What is a potential complication of a Mallory-Weiss tear?

A

Substantial blood loss, shock, collapse, haemorrhage

44
Q

what is the treatment for Mallory-Weiss tear?

A

Endoscopic haemostasis

45
Q

Give 3 red flag signs for GORD complications

A

weight loss, haematemesis, dysphagia

46
Q

Give 2 causes (not RF) of Gastro-Oesophageal Reflux Disease

A
  • 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
47
Q

give 3 non-intestinal symptoms of IBS

A

painful period, change in urinary symptoms, back pain, fatigue

48
Q

What is the name of the criteria used to diagnose Irritable Bowel Syndrome?

A

rome III diagnostic criteria

49
Q

what class of drug can be given to relieve bloating and the associated pain of IBS?

A

antispasmodics / anticholinergics

50
Q

what stimulates mucus secretion?

A

prostaglandins

51
Q

what is first line medication management of a H. pylori infection causing gastritis?

A

clarithromycin, amoxicillin and omeprazole

52
Q

what is the first line investigation for an abdo obstruction?

A

abdo XR

53
Q

does UC have skip lesions?

A

no

54
Q

name 4 causes of diverticulum

A
  • low fibre diet
  • obesity
  • NSAIDs
  • smoking
55
Q

name 2 things seen on duodenal biopsy in Coeliac?

A

villous atrophy and crypt hyperplasia

56
Q

what kind of anaemia is seen in Crohn’s disease?

A

iron and folate deficiency due to malabsorption

57
Q

name 3 sites where you might see a hernia?

A

inguinal, femoral, umbilical, incisional

58
Q

Other than to digest food give 3 functions of the stomach.

A
  • 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
59
Q

Define malabsorption.

A

Inadequate absorption of nutrients/food in/by the small intestines

60
Q

Why do 95% of abdominal aneurysms occur below the renal arteries but above the aortic bifurcation?

A

naturally contain less elastin in the arterial wall

61
Q

What area of Virchow’s triangle does an abdominal aortic aneurysm affect

A

stasis, abnormality in blood flow

62
Q

What size must an AAA reach to be considered operable?

A

> 5.5cm2

63
Q

State Laplace’s Law

A

R=1/r^4

64
Q

what do most colon cancers develop from?

A

polyps

65
Q

what proportion of colon cancers develop in the rectum?

A

1/3

66
Q

what is the most common type of carcinoma found in colorectal cancer?

A

adenocarcinoma

67
Q

What is the current bowel cancer screening programme?

A

faecal occult blood test in men/women aged 60-69

68
Q

What 2 methods can be used to stage CRC?

A

TNM / duke’s staging

69
Q

coeliac disease: what is the single most likely pathology to be seen on endoscopy?

A

villous atrophy

70
Q

give 4 extraintestinal symptoms of UC

A

Arthritis
Conjunctivitis
Clubbing (more common in CD)
Pyoderma Gangrenosum

71
Q

e.g. first line drug for diarrhoea in IBS?

A

loperamide - anti-motility agent

72
Q

name 3 risk factors for CD

A

family history, HLA-B27, caucasian, smoking, NSAIDs

73
Q

describe goblet cells in CD and UC

A

increased in CD, decreased in UC

74
Q

Name two other primary investigations / blood markers you may use in the diagnostic process for Crohn’s disease.

A
  • faecal calprotectin
  • FBC: leukocytosis in a flare up
  • CRP/ESR
  • U&Es
  • colonoscopy and biopsy

past questions (11 decks)

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