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Phase 2a Gastrointestinal system > GI > Flashcards

GI Flashcards

1
Q

Who does inflammatory bowel disease effect the most?

A

White + young adults

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2
Q

What is the cause of IBD + the associations?

A

Idiopathic but suggested associations with: Genetics (Crohn’s), the environment (smoking), and immune response (increased response to bacteria/Ag in both UC + CD)

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3
Q

What is the effect of smoking on the chance of getting IBD?

A

Increased risk in Crohn’s and decreased risk in UC

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4
Q

What is the cancer risk in IBD?

A

Increased (+ a bigger increase in UC compared to Crohn’s)

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5
Q

Describe the distribution of UC lesions in the GI system compared to CD (Crohn’s)?

A

UC: continuous from rectum (but only affects the large intestine)
CD: patchy distribution (mouth to anus)

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6
Q

What layers of the GI system are affected in UC compared to Crohn’s?

A

UC: Mucosa
CD: All layers (mucosa –> muscularis propria + adventitia)

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7
Q

What is the macroscopic intestinal of UC compared to Crohn’s?

A

UC: inflamed colon w/ polyps

Crohn’s: cobblestone appearance

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8
Q

What is the microscopic appearance of UC compared to Crohn’s?

A

UC: ulcers, no granuloma, crypt abscesses, depleted goblet cells
CD: Granuloma (non-caseating), goblet cells

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9
Q

What is the big symptom in Crohn’s?

A

Weight loss + diarrhoea

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10
Q

What is the big symptom in UC?

A

Bloody diarrhoea w/ mucus

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11
Q

Give 4 symptoms of UC

A

Malaise/lethargy, proctitis, diarrhoea, lower abdo pain

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12
Q

Give 3 symptoms of Crohn’s

A

Diarrhoea, WEIGHT LOSS, pain on defacation

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13
Q

What MSK conditions are Crohn’s and UC linked to?

A

HLA B27 +ve seronegative spondyloarthropathies

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14
Q

Give 3 signs of UC

A

Mouth ulcers, rectal bleeding, signs of malnutrition

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15
Q

Give 3 signs of Crohn’s

A

Perianal disease (anal tags, haemorrhoids…), signs of malnutrition, mouth ulcers

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16
Q

What are some examples of extraintestinal manifestations of IBD

A

Erythema nodosum, clubbing, uveitis, IBD ARTHRITIS, ankylosing spondylitis (seronegative spondyloarthropathy), anaemia

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17
Q

What are the general Ix’s you would carry out for a patient presenting with IBD? What will the tests show?

A

Blood cultures + stool sample (exclude infective cause of diarrhoea), bloods (anaemia, ^ inflammatory markers, ^WCC)

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18
Q

What is the gold standard Ix for UC?

A

Colonoscopy

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19
Q

What might you do to Ix Crohn’s?

A

barium swallow small bowel imaging

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20
Q

What would you do to diagnose UC?

A

Colonoscopy + rectal biopsy

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21
Q

What would you do to diagnose Crohn’s?

A

Sigmoidoscopy + rectal biopsy

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22
Q

What area of the GI tract does Crohn’s favour?

A

Terminal ileum

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23
Q

What disease is erythema nodosum a classical feature in?

A

Sarcoidosis (red lesions on shins)

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24
Q

What is the 1st line of the treatment for UC and Crohn’s?

A

Induce and maintain remission

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25
Q

What is the general conservative management for UC?

A

treat anaemia + diarrhoea (codeine phosphate or loperamide)

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26
Q

What is the 1st line Rx to induce remission for UC?

A

1st: corticosteroid (prednisolone) or 5-ASA (sulfasalazine)

27
Q

What is the 2nd line Rx to induce remission for UC?

A

Use BOTH corticosteroid + 5-ASA

28
Q

Whatis the 3rd line Rx to induce remission for UC?

A

Admit the pt

29
Q

How do you maintain remission in UC?

A

5-ASA (sulfasalazine)

30
Q

What is the 2nd line curative treatment for UC? What is this based on?

A

Surgery (colectomy w/ iliostomy). Based on the idea that there is a clear distinction in healthy and pathological bowel

31
Q

What is the conservative management for Crohn’s?

A

SMOKING CESSATION, Rx anaemia + diarrhoea

32
Q

How do you induce remission for Crohn’s?

A

Corticosteroid + anti-TNFalpha

33
Q

Give an example of anti-TNF treatment?

A

Infliximab, adalimumab, etanercept (TNF receptor)

34
Q

How would you maintain remission in Crohn’s?

A

5-ASA (sulfasalazine)

35
Q

What does 5-ASA stand for?

A

5-aminosalicylic Acid

36
Q

What are SEs of 5-ASA?

A

GI upset (abdominal pain, nausea, cramping…etc)

37
Q

Give an example of an anti-emetic. How does it work?

A

Ondasetron. A serotonin 5-ht3 receptor antagonist

38
Q

Who is commonly affected by Coeliac disease?

A

White, IRISH, N. Europe

39
Q

What is Coeliac disease?

A

A gluten sensitive enteropathy - an autoimmune disease

40
Q

What contains gluten?

A

Wheat, barley and rye

41
Q

What is the toxic protein in gluten?

A

Gliadin

42
Q

What diseases give you increased risk of getting coeliac?

A

T1DM, thyroid diseases, atopy

43
Q

Describe the pathology of coeliac disease

A

Gliadin crosses damaged intestinal epithelium –> MHC binds to gliadin and presents it on HLA DQ2 or DQ8 to a Th cell –> Th cell releases inflammatory cytokines

44
Q

What do the inflammatory cytokines Th cells release in response to binding to an APC presenting gliadin?

A

Villous atrophy, crypt hyperplasia, B cell activation, increased expression of HLA DQ8/DQ2 on intestinal epithelium

45
Q

What antibodies to activated B cells produce?

A

IgA tTG (tissue transglutaminase), EMA (anti-endomysial antibody), IgA + IgG to gliadin

46
Q

In terms of symptoms/signs, what effects does villous atrophy have?

A

Malabsorption (weight loss), anaemia (reduced Fe + B12 absorption), diarrhoea (reduced water absorption), steatorrhoea (reduced fat absorption)

47
Q

What are the symptoms of anaemia

A

Fatigue, lethargy, malaise…etc

48
Q

What are some other symptoms of Coeliac disease?

A

Infertility, abdominal pain, bloating

49
Q

What is a unique sign found in Coeliac disease?

A

Dermatitis herpetiformis

50
Q

What other sign can be found in Coeliac disease?

A

Distension, weight loss..etc

51
Q

What are the two risks associated with Coeliac disease?

A

Increased risk of cancer (particularly lymphoma), osteoporosis

52
Q

What Ix’s might you carry out in someone with Coeliac disease?

A

Serology, 4 or more duodenal biopsies, DEXA scan

53
Q

What are you looking for in serology to Ix Coeliac disease?

A

tTG, EMA, IgG/IgA to gliadin

54
Q

How many duodenal biopsies do you need to diagnose Coeliac disease and how long must a person keep gluten in their diet for?

A

4 or more + 6weeks

55
Q

What does a duodenal biopsy demonstrate in coeliac disease?

A

Villous atrophy, crypt hyperplasia, ^ intraepithelial lymphocytes

56
Q

What is the classic presentation of a Mallory Weiss tear?

A

A history of persistent vomiting + retching before haematemesis

57
Q

What must you do before doing an oesophageal endoscopy?

A

Stop NSAIDs + give PPI (omeprazole)

58
Q

What do peptic ulcers encompass?

A

Gastric and duodenal ulcers

59
Q

When do those with duodenal ulcers get epigastric pain?

A

At night and when hungry (relieved by eating)

60
Q

How would you eradicate H. pylori?

A

Triple therapy: omeprazole, amoxicillin + metronidazole

61
Q

How would you treat peptic ulcer not caused by H. pylori?

A

Stop NSAIDs (use COX-2 inhibitors instead), PPI (omeprazole), treat complications

62
Q

What are the complications of a peptic ulcer?

A

Perforation (causing peritonitis), gastric outlet obstruction (fibrosis/scarring), haemorrhage

63
Q

What positions are direct and indirect inguinal hernias to the inferior epigastric artery?

A

Direct: medial
Indirect: lateral

Phase 2a Gastrointestinal system (4 decks)

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