Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Gastrointestinal > GI - 2 > Flashcards

GI - 2 Flashcards

1
Q

Definition of GORD

A

oesophageal pH <4 for >4% for a 24hr period on pH monitoring; issues with oesophageal clearance, LOS competence, gastric clearance
Regurgitation of acidic gastric contents into the lower oesophagus → acid injures squamous epithelium → inflammation (reflux oesophagitis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

RF of GORD

A 
Obesity 
Pregnancy
Smoking
Alcohol
Consumption
Hiatus hernia 
Ca-blockers, nitrates
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Clinical presentation of GORD

A 
Regurgitation of acid contents into the mouth
Oesophagitis (heart burn)
Barrett's oesophagus
Stricture
Bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

SSx of GORD

A 
Heartburn
Belching
Acid brash
Water brash
Odynophagia 
Nocturnal asthma
Chronic cough, laryngitis, sinusitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Complications of GORD

A

Oesophagitis, ulcers, benign stricture, Fe deficiency, Barrett’s oesophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Ix GORD

A

hx, OGD + biopsy (quadrantic biopsies - i.e. 4x, one from each quarter of oesophagus at 2cm intervals), pH monitoring, manometry, barium swallow (may show hiatus hernia)

Urgent endoscopy: ALARMS - Anaemia, loss of weight, anorexia, recent onset of progressive symptoms, melena or haemoptysis, swallowing difficulty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Rx GORD

A

Conservative: weight loss, alcohol, smoking, prop up @ night, small regular meals. Avoid hot drinks, alcohol, spocy food, caffeine eating before bed, drugs impacting contractility or damaging mucosa (nitrates, anti-cholinergic’s, Ca channel blockers // NSAIDS, K+ salts, bisphosphonate)
Medical: antacids, PPI, H2 antagonists, metoclopramide
Surgical: Nissen;s fundoplication, aim to resting lower oesophageal sphincter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Barrett’s oesophagus

A

metaplastic process as an adaptive response to prolonged injury by GORD in lower oesophageal mucosa
One mature cell type replaced with another, adaptive, potentially reversible, predisposes dysplasia (pre-malignant). Asymptomatic, identified via OGD for upper GI symtoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Barrett’s to carcinoma

A

<2% pts with Barrett’s oesophagus

metaplastic columnar epithelium -> dysplasia -> invasive adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

SSx oesophageal cancer

A

asymptomatic OR dysphagia/painful swallowing, weight loss, retrosternal chest pain, indigestion, coughing/ hoarseness, recurrent laryngeal nerve palsy, haematemesis, aspiration pneumonia
Dysphagia: progresses from solids to liquids
Weight loss & other non-specific symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Ix and staging of oesophageal cancer

A

OGD, biopsy, barium swallow, endoscopic US

Staging: OGD, CT chest/abdo, PET CT, endoscopic US, bronchoscopy, analysis of gene expression profiles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Types of oesophageal cancer

A 
Typically middle (50%), lower (30%), upper (20%)
Usually: adenocarcinoma. Barrett's, GORD, smoking, obesity, lower 1/3rd
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Benign tumours of the oesophagus

A

Leiomyoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

SCC of oesophagus

A

2nd most common oesophageal cancer in the UK

Arises from native oesophageal squamous epithelium. RF smoking, alcohol, achalasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Rx oesophageal cancer

A

Surgery: pts with no mts and resectable cancer. McKeown / Ivor Lewis oesophagectomy
Non-surgical: endoscopic Rx (ESD), endoscopic ablation therapies
Palliation: stenting, chemo/radiotherapy, laser therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Motility disorders causing dysphagia

A

Bulbar palsy (stroke, MND)
Diffuse esophageal spasm
Achalasia
Systemic sclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Mechanical / structural disorders causing dysphagia

A

Liquids easier than solids, constant, neck bulges / gurgles on drinking
Oesophageal ca, benign stricture, cricoid web, extrinsic pressure (bronchial ca, AA, goitre, LA enlargement MS), pharyngeal pouch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Causes of odynophagia

A

Painful swallowing
Inflammation: reflux oesophagitis, peptic oesophageal ulceration
Infection: thrush, Herpes, viral/ bacterial pharnygitis
Spasm: diffuse oesophageal spasm
Ix: hx, exam, OGD, barium swallow, manometry, pH studies, CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Pharyngeal pouch

Definition, SSx, Ix, Rx

A

Diverticulim of mucosa of the pharynx causing dysphagia, gurgling on swallowing, halitosis
Ix: barium swallow, OGD, CT
Rx: leave if asymptomatic, if large - endoscopic stapling, fibre-optic diverticulum repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Achalasia definition, SSx, Ix, Rx

A

Increased resting tone to LOS, failure to relax, high resting pressure, poor generalised peristalsis of oesophagus
SSx: dysphagia, regurgitation of all food, retrosternal chest pain on and off, weight loss, pre-synope
Ix: CXR, OGD, barium swallow, manometry
Rx: lifestyle, nifedipine, balloon dilation, botox to LOS, Heller’s cardiomyotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Diffuse oesophageal spasm

A

Intermittent, hard to diagnose, causes significant retrosternal pain
Ix: OGD, barium swallow, manometry
Nifedipine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Definition of peptic ulcer

A

Breach in mucosa through muscularis propria of GI tract which fails to heal over a reasonable amount of time
Most commonly gastric antrum / proximal duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Pathophysiology of PUD

A 
Chronic inflammation (tissue injury at surface, ongoing inflammatory response, attempts to heal by fibrosis)
Normal mucosal defect mechanisms, peptic ulcers occur by weakened defence mechanisms or increase acid attack (Zollinger-Ellison syndrome, H. pylori, shock)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

RF PUD

A 
H. pylori
NSAIDs
Alcohol
Smoking
Acidic foods
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

SSX PUD

A

reflux, recurrent epigastric burning / chest pain, heart burn related to eating, fullness / bloating, N&V hours after meal, dyspepsia, haematemesis melena, generalised abdo pain, guarding, rebound tenderness, cough test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

ALARM features

A 
Anaemia
Loss of weight
Anorexia
Recent onset progressive dysphagia
Melena / haematemesis
Swallowing difficulty
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Complications of PUD

A

Bleeding: melena / heamatemesis
Perforation: ulcers erode through all layers of wall -> peritonitis
Stricture: formation due to healing of ulcer by fibrosis
Malignant change: rare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Gastric vs duodenal ulcer

A

G: pain on eating and thinking about eating, GU oozes blood, causing gastritis, can cause gastric outlet obstruction. Typically elderly, on lesser curve
D: better with eating, pain before meals, 4x more common than GU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Ix PUD

A

fBC, U&E, LFT, CRP
OGD +/- biopsy, CXR/AXR
H. pylori testing
Serum IgG, raised urease, CLO, urea breath test, faecal stool antigen test
Biopsy
Fasting serum gastrin level if Zollinger-Ellison syndrome suspected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Rx PUD

A

C: weight loss, smoking cessation/ drinking, NSAIDS, avoid acidic food
M: H pylori triple therapy (omeprazole/ amoxicillin / clarithromycin)
Anti secretory therapy: PPI / H2 blockers
OTC antacids
S: perforation, bleeding, obstruction
Follow up rescope in 6wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Presentation of gastritis

A

Epigastric pain
Vomiting
Haematemesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Causes of gastritis

A 
Alcohol
NSAIDs
H. pylori reflux
Hiatus hernia
atrophic gastritis
Granulomas (Crohn's, sarcoidosis)
CMV, Zollinger Ellison
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Prevention, diagnosis and treatment of gastritis

A

P - PPI gastroprotection with NSAIDs
D - endoscopy and biopsy
Rx - ranitidine or PPI, eradicate H. pylori

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Epidemiology of gastric cancer

A

> 50s
M>F
Incidence has fallen in West due to falling H. pylori and improved diet

35
Q

RF gastric cancer

A

H. pylori infection & chronic ulcers (but remember, most people with H pylori infection will not develop cancer).
Cigarette smoking.
Alcohol.
Diet (food with nitrates/nitrite components; salt-based preservatives), obesity
Chronic atrophic gastritis and pernicious anaemia
Barrett’s oesophagus
Previous gastric resection/ radiation therapy
Adenomatous gastric polyposis

36
Q

Clinical presentation of gastric cancer

A 
Dyspepsia 
Unintentional weight loss
Progressive dyphaia
Epigastric pain
Vomiting
Early satiety
Occult GI bleeding
Virchow's node
37
Q

Spread of gastric cancer

A

Direct - pancreas, colon, liver
LNs
Blood (lung, bone)
Trans-peritoneal

38
Q

Ix gastric cancer

A

OGD and biopsy, barium studies, CT chest / abdo endoscopic US, PET

39
Q

Rx gastric cancer

A

Resection if caught early

40
Q

What happens to the liver in cirrhosis

A

Increased fibrosis, shrinkage, decreased hepatocellular function, obstruction of bile flow

41
Q

Definition of jaundice

A
  • Yellowing of the skin, sclerae, mucosae from increased plasma bilirubin (visible at >60umol/L – normal serum bilirubin is <17umol/L, excess is clinically detectable >35umol/L)
42
Q

Causes of jaundice in previously stable cirrhosis pt

A

Sepsis
Malignancy
Alcohol / drugs
GI bleeding

43
Q

Important Hx points in jaundiced patient

A 
Transfusions
IV drugs
Piercings
Tattoos
Sexual activity
FHx
Alcohol
Medications
44
Q

Ix jaundice

A

Screening tests for suspected liver disease
Urine: bilirubin absent in pre-hepatic
Haem: FBC, clotting film, reticulocyte count, coomb’s test, haptoglobulins, malaria parisites, EBV
Chem: U&E, LFTs, Gamma-GT, total protein, albumin, paracetamol
Microbiology: blood anf other cultures, serology
Imaging: US, ERCP, MRCP, liver biopsy, CT/MRI for abdominal malignancy

45
Q

Pre-hepatic jaundice

A

Excess bilirubin presented to liver
Unconjugated, hyperbilirubinaemia, water insoluble (doesn’t enter urine), sickle cell crisis, blood transfusion, haemolytic drugs / anaemia
Normal coloured urine, +++ urobilinogen, normal / dark stools, no pruritus, normal LFTs

46
Q

Hepatocellular jaundice

A

Cannot conjugate bilirubin, leaks conjugated bilirubin initially - so both can be elevated in serum
Caused by hepatitis, cirrhosis, hepatic carcinoma / mets, drugs, sepsis, liver abscess, budd chiari
Dark urine, + urobilinogen, ++ conjugated bilirubin + bile salt
Normal stools, high AST/ALT

47
Q

Post-hepatic jaundice

A

Intra/extra-hepatic causes (e.g. impaired hepatic excretion - choleasis)
Conjugated hyperbilirubinaemia
Gallstone in CBD
Malignancy (head of pancreas)
Inflammation (cirrhosis, sclerosis, cholangitis)
Drugs
Biliary atresia

48
Q

Causes of hepatitis

A

Viral
Drugs
Alcohol
Autoimmune

49
Q

SSx Hepatitis

A

Fever, malaise, N&V, arthralgia, hepatomegaly, pain, jaundice

50
Q

Ix hepatitis

A

Antibodies, elevated ALT/AST to 1,000s, typical lymphocytosis, viral serology

51
Q

Autoimmune hepatitis

A

Acute hepatitis and signs of autoimmune disease
Fever, malaise, urticarial rash, polyarthritis, pleurisy, pulmonary infiltration, glomerulonephritis
Anti-smooth muscle antibodies
Rx: Prednisolone, azathioprine, liver transplant in decompensated cirrhosis

52
Q

Hepatitis A

A

ssRNA virus
F-O transmission
Rare, blood products
Acute and mild incubation 15-50d
Ix HAV IgM antibody (active) or IgG (recovery / vaccination)
Prevention: hygiene, 7d isolation, vaccine available, pre/post- exposure

53
Q

Hepatitis E

A 
ssRNA virus
Pregnant women most susceptible - high mortality
F-O transmission
HEV IgM and IgG
No vaccine, no Rx
54
Q

Hepatitis C

A 
ssRNA virus
chronic liver changes
Blood transmission
Incubation 14-180d
HCV RNA using PCR
IgI on enzyme immunoassay
No vaccine, curable in some, antivirals / interferon free treatment
55
Q

Hepatitis B

A

ds DNA virus
Most common cause of hepatocellular
Blood transmission
Pre-exposure vaccine available

56
Q

Definition of cirrhosis

A

Irreversible chronic scarring / fibrosis and damage do to chronic hepatic injury

57
Q

Causes of cirrhosis

A

Alcohol
NAFLD
viral hepatitis
Genetic: haemochromatosis, wilson’s, a1-antitrypsin deficiency
Autoimmune: 1o billiary sclerosis, 1o sclerosing cholangitis
udd chiari
CCF, schostosomiasis, parenteral nutrition related
Drugs: amiodarone, methlydopa, methotrexate

58
Q

SSx cirrhosis

A

ascites, splenomegaly, porto-systemic shunts, hepatorenal failure (renal vasoconstriction, decreased perfusion), reduced liver function
Hepatic encephalopathy
Metabolism of oestrogen (gynaecomastia, palmar erythema)
Bilirubin conjugation - jaundice
Albumin production - hypoalbuminaemia
Clotting factor production
Portal hypertension

59
Q

Ix cirrhosis

A

Bloods

Full liver pane including autoantibodies, liver US and duplex MRI, ascitic tap

60
Q

Rx cirrhosis

A

Nutrition, alcohol abstinence, avoid NSAIs, sedatives and opiates
Cholestyramine helps pruritus
Ursodeoxycholic acid for hepatitis induced cirrhosis & 1o biliary cirrhosis (normalises LFTs but nor impact on progression)
Penicillamine for Wilson’s
Spironolactone, fluid restriction (add furosemide if poor response) for ascites
SBP Rx: cefotaxime or tazosin
Manage renal failure HCC screening

61
Q

Tool for prognosis in cirrhosis

A

Child-Pugh score

Bilirubin, serum albumin, INR, ascitis, encephalopathy

62
Q

Alcohol metabolism

A

Less fatty acid oxidation and NADH making more fatty acids - increased fat production, hepatic steatosis
ROS - protein and DNA damage
Acetaldehyde
Stop alcohol, steroids to immunosuppress

63
Q

NAFLD

A

Steatosis +/- steatohepatitis
20% in gen pop, 70% in T2DM
RF: obesity, DM, paerenteral feeding, JI bypass, Wilson’s drugs
Rx: control RF, bariatric surgery

64
Q

RF pancreatic cancer

A

smoking, alcohol, carcinogens, DM, chronic pancreatitis, obesity
KRAS2 mutation

65
Q

common pancreatic cancer

A

adenocarcinoma of glandular duct cells that line ducts of exocrine system
60% in head, 25% in body
Elderly males

66
Q

Clinical presentation of pancreatic cancer

A 
Obstructive jaundice
Weight loss
Mid epigastric pain
Palpable gall bladder
Epigastric mass
67
Q

Ix pancreatic cancer

A 
Bloods - Ca19-9
Us - dilated bile ducts
Distended gall bladder
CT
Endoscopy
MRCP/ERCP
68
Q

Rx pancreatic cancer

A

most present with metastatic disease <20% suitable for radical surgery
Palliative: chemotherapy, stenting the common bile duct to relieve jaundice and optimising symptom control
Curative: Whipple’s procedure (tumour confined to the pancreas and lymph nodes are not involved)
Whipple’s Pancreatico-duodenectomy
Distal stomach, gallbladder, CBD, head of pancreas, duodenum, proximal jejunum and regional lymph nodes are resected
o5yr survival 20-40% are Whipple’s (vs 5% without – including those with advanced disease)

69
Q

Insulinoma

A

B cell tumour
90% are benign
SSx: hypoglycaemia
Ix: insulin levels, C-peptide, CT/MRI, endoscopic US
Rx: tumour excision (Whipple / distal pancreatectomy)

70
Q

Whipples triad

A

Hypoglycaemia
During starvation
Relieved by sugar

71
Q

Crohn’s vs UC

NESTS vs CLOSE UP

A

NESTS vs CLOSEUP
No blood or mucus, entire GI tract, skip lesions on endoscopy, terminal ileum mist affected, transmural (full thickness), smoking is a risk factor
Continuous inflammation, limited to colon and rectum, only superficial muscosa affected, smoking is protective, excrete blood and mucus, use aminosalicyclates, primary sclerosing cholangitis

72
Q

How does IBD present?

A

diarrhoea
abdo pain
Passing blood
Weight loss

73
Q

Ix for IBD

A 
Routine bloods for anaemia, infection, thyroid, kidney, liver function
CRP
Faecal calprotectin
Stool MC&S
AXR
Endoscopy (OGD/colonoscopy) with biopsy
US, CT, MRI for complications
74
Q

Rx crohn’s

A

Inducing remission - steroids, if unsuccessful add immunosuppressant
Maintaining remission - e.g. azathioprine
Surgery - when disease only affects distal ileum this area can be surgically resected to prevent further flares. Can also treat 2o strictures and fistulas

75
Q

Rx UC

A

Inducing remission: aminosalicyclates / corticosteroids / ciclosporin
Maintaining remission: aminosalicyclate, azathioprine
Surgery: Removal of the colon and rectum, leaving either a permanent ileostomy / ileo-anal anastomosis (J-pouch).

76
Q

Truelove and Witt’s criteria

A

Rectal bleeding, temperature, HR, BPM, Hb, ESR

Mild/ moderate/ severe

77
Q

Why image in crohn’s

A 
Diagnosis
Extent and severity
Treatment response
Complications
Surgical planning
78
Q

What is IBS?

A

A functional disorder - no inflammation, ulcers or damage to bowel
Abnormal functioning of otherwise normal bowel

79
Q

SSx IBS?

A 
Diarrhoea
Constipation
Fluctuating bowel habit
Abdo pain
Bloating
Worse after eating
Improved by opening bowels
80
Q

Ix IBS?

A

Other pathology should be excluded
Normal FBC, ESR, CRP
Faecal calprotectin negative, negative anti-TTG antibodies
cancer not suspected / excluded

81
Q

Rx IBS?

A

General healthy diet and exercise - adequate fluid, regular small meals, low produced foods, limit caffeine and alcohol, low FODMAP, probiotics
1st line - loperamide for diarrhoea, laxatives for constipation, antispasmodics for cramp
2nd line - tricyclic antidepressants (amitriptyline)
3rd line - SSRIs
CBT

82
Q

SSx malabsorption syndrome

A

Diarrhoea, weight loss, lethargy, steatorrhoea, bloating, signs of deficiency (anaemia, bleeding disorders, oedema, metabolic bone disease, neurological features)

83
Q

Ix malabsorption syndrome

A

Bloods – FBC, low Ca / Fe / B12 / folate, high INR, lipid profile, coeliac profile
Stool – analyse for fat, MC&S, a1-AT
Breath hydrogen analysis for bacterial overgrowth
Endoscopy and small bowel biopsy, ERCP

84
Q

Causes of malabsorption syndrome

A

Coeliac, chronic pancreatitis, Crohn’s
Low bile - 1o biliary cirrhosis, ileal resection, biliary obstruction
Pancreatic insufficiency - pancreatic cancer, CF
Small bowel mucosa - Whipple’s disease, radiation enteritis, tropical sprue, bowel resection, brush border enzyme deficiencies, drugs (metformin, neomycin, alcohol), amyloid
Bacterial overgrowth - DM & PPI are risk factors
Infection - giardiasis, diphyllobothriasis, strongyloidiasis
Intestinal hurry - post-gastrectomy dumping

Gastrointestinal (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions