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Phase 2a > GI > Flashcards

GI Flashcards

1
Q

Define a anorectal abscess

A

Infection of soft tissue around the anus

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2
Q

Describe the pathophysiology of anorectal (perianal) abscess

A

If crypt does not drain into anal canal

Infection may spread along the inter-sphincteric space - result in inter-sphincteric, perianal or supra-Levator abscess

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3
Q

Describe the causes of anorectal abscesses

A

Majority = infection of the anal glands - cryptoglandular infections

Gland may become occluded due to:
- impaction of food matter
- oedema from trauma secondary to a hard stool or foreign body
- result of an adjacent inflammatory process e.g. Crohn’s disease

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4
Q

Name 3 risk factors of anorectal abscesses

A

Anal fistula (related with 30-70% of cases)

Crohn’s disease

Male sex

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5
Q

Describe the clinical features of anorectal abscesses (perianal)

A

Most common = severe perianal pain + swelling

+ leucocytosis

Other features
- fever
- chills
- urinary retention

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6
Q

Describe the investigations of anorectal (perianal) abscess

A

Diagnosis = physical examination

Other investigations
- blood
- imaging

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7
Q

Describe the management of anorectal (perianal) abscess

A

1st line = incision and drainage

Antibiotics in indicated patients - not an alternative to surgical drainage

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8
Q

Name the differential diagnosis of anorectal (perianal) abscess

A

Anal fissure
Thrombosed haemorrhoid
Pilonidal abscess
STIs

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9
Q

Name a complication of perianal abscess

A

Anal fistula

30-50% of patients will develop an anal fistula in months/years following drainage

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10
Q

Name 3 causes of colonic ischemia

A

Occlusion of the blood supply (mesenteric) arteries by:

Trauma
Thrombosis
Immobilisation

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11
Q

Name the risk factors of colonic ischemia

A

Old age
History of smoking
Hypercoagulable state
Atrial fibrillation
Myocardial infarction
Structural heart defects
History of vasculitis

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12
Q

Describe the clinical features of colonic ischemia

A

Sudden onset of mild, crampy, abdominal pain - usually localised to the left lower quadrant

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13
Q

Describe the investigations of colonic ischemia

A

Imaging
- sigmoid or colonoscopy
- CT angiography
- ECG

Blood investigations

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14
Q

Describe the management of colonic ischemia

A

Treatment varies of severity of presentation

Most cases resolve spontaneously

Severe/continuing symptoms
- admission
- supportive measures
- bowel rest
- investigations to underlying cause

LMWH

Surgical interventions

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15
Q

Define pseudomembranous colitis

A

Characterised by inflammation in the large intestine, with yellow/white plaques that form pseudomembranous membranes on the inner surface of the bowel wall

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16
Q

Describe the pathophysiology of pseudomembranous colitis

A

Disruption of colonic biome = allows for difficle colonisation

C. difficle induces colitis via exotoxin production, toxin A and B

Toxins = inflammation, colonic cell cytoskeleton disruption and cellular death.

Pseudomembranes form as these toxins pathologically hyper stimulate the native immune system by drawing neutrophils to invade the colonic mucosa

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17
Q

Name the causes of pseudomembranous colitis

A

Main = C. difficle

Others
- ischemic colitis
- IBD
- vasculitis
- bacterial/parasitic organisms

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18
Q

Name the risk factors of pseudomembranous colitis

A

Same as C. difficle

Hospitalisation
Antibiotic use
Chemotherapy exposure
Marked leukemoid reactions

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19
Q

Describe the symptoms of pseudomembranous colitis

A

Most common - symptomatic diarrhoea

Fever
Abdominal cramping
Leucocytosis

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20
Q

Name the signs of pseudomembranous colitis

A

Leucocytosis
Hypovolemia
Hypotension
Protein-losing enteropathy
Reactive arthritis
Toxic megacolon

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21
Q

Name the investigations of pseudomembranous colitis

A

Colonoscopy

Biopsy - Owl’s eye inclusion bodies

Diagnosis = colonoscopy + biopsy

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22
Q

What is the 1st line of treatment for C. difficle

A

Oral vancomycin

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23
Q

Define Mallory Weiss Tear

A

Tear in the lower oesophageal mucosa due to sudden increase in intra-abdominal pressure causing haematemesis

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24
Q

Name 3 risk factors for Mallory Weiss Tear

A

Hyperemesis gravidarum - severe vomiting in pregnancy

Bulimia

Alcoholism

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25
Q

What is the treatment for Mallory Weiss Tear

A

Self resolves

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26
Q

What artery is affected in a gastric ulcer

A

Gastroduodenal artery

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27
Q

What artery is affected in a duodenal ulcer

A

Left gastric artery

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28
Q

Describe the clinical features of a small bowel obstruction

A

Colicky abdominal pain - located higher

Vomit them constipation

Mild distention

Tinkling bowel sounds

Coiled spring appearance - x-ray

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29
Q

Describe the clinical features of a large bowel obstruction

A

Continuous abdominal pain

Constipation then vomiting

Gross distention

Sounds
1. Hyperactive then
2. Normal then
3. Absent

X-ray coffee bean appearance

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30
Q

Name 2 symptoms of a gastric ulcer

A

Haematemesis

Melena (black tarry stools)

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31
Q

Name 2 symptoms of a duodenal ulcer

A

Melena

Haematochezia - passage of blood in stool

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32
Q

Define GORD

A

Reflux of acidic contents into the oesophagus due to incompetent LES or high intra-abdominal pressure overcoming sphincter mechanisms

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33
Q

Name the risk factors of GORD

A

Increased intra-abdominal pressure - pregnancy or obesity

Incompetent LES

Hiatus hernia - sliding 80%, rolling 20%

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34
Q

Name the symptoms of GORD

A

Retrosternal burning chest pain

Dysphagia, odynophagia

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35
Q

Name a red flag of GORD that would result in a 2 week wait

A

Dysphagia

36
Q

What would be the next steps in GORD if there were no red flag symptoms

A

Clinically diagnose + treat

37
Q

If red flags of GORD describe the investigations

A

1st line = oesophageal-gastro duodenoscopy (OGD) - oesophagitis, Barrett’s oesophagus

2nd line (if normal) - oesophageal manometry, 24 hour gastric pH monitoring

38
Q

Describe the management of GORD

A

Conservative

Medical management

Surgical
- laparoscopic Nissen’s fundoplication

39
Q

Describe the medical management of GORD

A

Sort term anti acids

1st line = PPI 4-8 weeks

2nd line = H2 receptor antagonist

40
Q

Describe a laparoscopic Nissen’s fundoplication

A

Fundus wrapped around lower oesophagus to mimic sphincter

41
Q

Define Barrett’s oesophagus

A

Metaplasia of distal oesophagus

Squamous to columnar epithelium

42
Q

What type of cancer can Barrett’s oesophagus cause

A

Oesophageal adenocarcinoma

43
Q

What is the cause of Barrett’s oesophagus

A

GORD complication - often due to sliding hiatus hernia

Caucasian male 50+

44
Q

Describe the investigation of Barrett’s oesophagus

A

OGD + biopsy

In z-line > (or equal to) 1cm above gastro-oesophageal junction

45
Q

Describe the treatment of Barrett’s oesophagus

A

Treat underlying cause reflux with PPI

Non dysplastic = surveillance endoscopy

Dysplastic = endoscopic mucosal resection or radiofrequency ablation

46
Q

Name 4 causes of GI bleeding

A

Peptic ulcer

Oesophageal varices

Mallory-Weiss tear

Stomach cancer

47
Q

Name 3 signs of GI bleeding

A

Melaena

Haematemesis

Coffee-ground vomit

48
Q

Why is U&E important in GI bleeding

A

Blood enters GI tract - blood proteins are digested to amino acids - metabolised at liver to urea = increased blood urea nitrogen

49
Q

Describe the management of GI bleeding

A

Check ABCDE, Glasgow-Blatchford score

Endoscopy

Variceal bleeding
- antibiotics + terlipressin
- urgent endoscopy - 12 hours
- place band

Non-variceal bleeding
- common cause - peptic ulcer
- PPI
- endoscopy in 24 hours
- cortication or clip

50
Q

Define chrons disease

A

Characterised by patchy transmural granulomatous inflammation with skip lesions at any part of the GI tract (mouth to anus)

51
Q

Which IBD is this

patchy transmural granulomatous inflammation

A

Chrons disease

52
Q

Describe the presentation of chrons disease

A

RLQ pain
Non-bloody diarrhoea
Weight loss + malabsorption
Aphthous ulcers

53
Q

Where is the pain in chrons felt

A

RLQ

54
Q

Where does chrons affect most

A

Terminal ileum and proximal colon

55
Q

What deficiency’s may be seen in chrons disease

A

Haematinic deficiency - B12, Fe
Steatorrhea + fat soluble vitamin deficiencies

56
Q

Name the risk factors of chrons disease

A

Jewish
Bimodal incidence 15-20, 55+
Family history - NOD2/CARD15
Smoking

57
Q

In which IBD is smoking a risk factor

A

Chrons

58
Q

What is the GS investigation for chrons disease

A

Colonoscopy + biopsy

59
Q

How do you remember differentiating features of chrons disease

A

NESTS

60
Q

Breakdown NESTS

A

N - No blood or mucus (PR bleeding is less common\0
E - Entire GI tract affected (mouth to anus)
S - Skip lesions on endoscopy
T - Terminal ileum most affected, transmural (full thickness inflammation)
S - Smoking is a risk factor (do not set nests on fire)

+ strictures and fistulas

61
Q

How do you differentiate the features of UC

A

you see (UC) = CLOSEUP

62
Q

Breakdown CLOSEUP

A

C - continuous inflammation
L - limited to colon + rectum
O - only superficial mucosa affected
S - Smoking may be protective (UC less common in smokers)
E - Excrete blood and mucus
U - Use amino salicylates
P - primary sclerosing cholangitis

63
Q

What is the GS investigation for IBD

A

Colonoscopy + biopsy

64
Q

What are the antibodies associated with chrons disease

A

ASCA antibodies

65
Q

What is the 1st line management in a flare of chrons

A

Corticosteroids

Prednisolone (mild)

Hydrocortisone (severe)

66
Q

What is the 1st line management to maintain remission in chrons

A

Azathioprine + methotrexate

67
Q

What is the 2nd line management to maintain remission in chrons

A

Biologics

TNF-a inhibitor = rituximab
ILA-12&23 = Ustekinumab

68
Q

What is rituximab

A

TNF-a inhibitor

69
Q

What is ustekinumab

A

ILA-12&23

70
Q

Name the differentials of IBD

A

Diverticulitis
Coeliac disease
Colon cancer
IBS

71
Q

Define UC

A

Autoimmune colitis beginning @ rectum (proctitis) and extending proximally into the colon

72
Q

What does UC mostly affect

A

Terminal ileum

73
Q

Where is pain in UC felt

A

LLQ

74
Q

Name the risk factors of UC

A

Jewish
Bimodal incidence 15-20, 55+
Family history
HLA-B27
GI infection
NSAIDs

Non-smoking

75
Q

What is the GS investigation for UC

A

Colonoscopy + biopsy

76
Q

What would be seen on a abdo x-ray and barium enema in UC

A

Continuous lead pipe

77
Q

What scoring system is used in UC

A

Flare true love + witts

Scores severity

78
Q

What escalation system is used in UC

A

Travis criteria

79
Q

What is the GS management in UC

A

Surgery = curative

Partial or total colectomy

80
Q

What is the 1st line management for a flare of UC

A

Topical aminosalicylate (ASA)

81
Q

What is the 2nd line management for UC

A

Oral aminosalicylate or prednisolone

Biologics = TNF-a infliximab

82
Q

Where does UC never go beyond

A

Ileocecal valve

83
Q

What antibodies is UC associated with

A

p-ANCA antibodies

84
Q

What gene is UC associated with

A

HLA B27 gene

85
Q

Name a complication of UC

A

Toxic megacolon

86
Q
A

Phase 2a (15 decks)

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