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GI Flashcards

1
Q

Summary of GI pathology?

A

Upper GI: Oesophageal/Stomach/SI pathology

Lower GI: Diverticular/IBD, Polyps, Adenoma, CRC,

Infective GE
Intra-abdominal infections
Nutritional support in trauma

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2
Q

What is the most common cause of oesophagitis?

A

Gastro-oesophageal reflux

infection if immunocomp/ corrosives

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3
Q

State 5 risk factors for reflex oesophagitis.

A 
Male
Caucasion
Overweight
Defective LES
Hiatus heria
Increased intra-abdo pressure
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4
Q

Ulceration/Haemorrhage/Perforation/Strictures are possible complications of long-standing reflux oesophagitis.

What is another one which is a pre-malignant condition?

A

BARRETT’S OESOPHAGUS

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5
Q

What are the risk factors for Barrett’s oesophagus?

A

Same as reflex oesophagitis

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6
Q

State the histiological changes in Barrett’s oesophagus.

A

Glandular metaplasia

sq –> columnar

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7
Q

Those wth Barrett’s oesophagus require regular endoscopic surviellance. For what?

A

ADENOCARCINOMA

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8
Q

What are the 2 types of Oesophageal cancer?

A

Adenocarcinoma - from Barrett’s

Squamous Carcinoma - from native cells (middle/lower 1/3)

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9
Q

Which Oesophageal cancer has the same risk factors as Barrett’s/reflex oesophagitis?

A

Adenocarcinoma

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10
Q

Risk factors for Squamous carcinoma?

A 
Smoking
Alcohol
Thermal injury
HPV
Male
Black
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11
Q

The 2 oesophageal cancers have the same macroscopic appearence. Describe these.

A

Strictures
Ulcerated
Fungating
Polypoidal

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12
Q

Causes of Chronic gastritis?

A

ABC: Autoimmune, Bacterial (H.pylori), Chemical injury

NSAIDs
Bile reflux

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13
Q

H.pylori is associated with which 2 cancers?

A

Gastric cancer

MALT Lymphoma

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14
Q

What effects does H.pylori have on the stomach?

A

Chronic inflammation (mucosa)

Glandular atrophy (fibrosis, intestinal metaplasia)

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15
Q

What is defined as a localised defect extending to the submucosa +

A

Peptic ulcer

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16
Q

Name 5 causes of peptic ulcers

A 
H.PYLORI
Smoking
NSAIDs
Hyperacidity
Duodenl-gastro reflux
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17
Q

Is duodenal or gastric ulcer more common?

What is it always almost caused by?

A

Duodenal

H.PYLORI

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18
Q

Complications of peptic ulcers?

A

Haemorrhage
Perforation
Penetrate adjacent organs
Stricturing (hour-glass deforming –> reflux)

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19
Q

The most common type of gastric cancer is MALT lymphoma. T/F?

A

F

ADENOCARCINOMA

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20
Q

Adenocarcinoma of the GOJ has the same risk factors as Reflux oesophagitis.

What are the risk factors for Adenocarcinoma of body/antrum?

A

H.Pylori
Diet
Hypochlrohydria
Bile reflux

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21
Q

Gastric cancer in

A

HDGC

Hereditary diffuse-type

(scattered growth)

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22
Q

Other uncommon forms of gastric cancer?

A

Endocrine tumours
GIST
MALT lymphoma

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23
Q

Coeliac D is autoimmune and gliadin induces IL-15 expression –> CD8 IEL activation –> villi atrophy.

T/F?

A

T

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24
Q

Give 4 symptoms of Coeliac D.

A

Anaemia

Chronic diarrhoea

Bloating (bacteria)

Chronic fatigue (malabsorption)

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25
How would you investigate for Coeliac D?
Antibodies Biopsy
26
If got symptoms despite gluten-free diet, what would this suggest?
Cancer
27
Are diverticula are inward or outward protrusion of mucosa and submucosa?
OUTWARD
28
Diverticula are associated with...?
West Urban Elderly Low fibre
29
Most diverticula present as...? Other presentations?
Asymptomatic (90%) Abdo pain Alternating diarrhoea/constipation
30
Diverticulosis, Perforation, Haemorrhage are examples of what?
Acute complications of diverticula
31
Intestinal obstruction, Fistula, Colitis, Polypoid prolapsing mucosa folds are examples of what?
Chronic complications of diverticulosis
32
IBD is a form of chronic colitis. T/F?
T
33
3 Risk factors for IBD?
Smoking Oral contraceptive FH
34
The longer you have UC, the more likely you are to develop CRC. What is neccessary after 10yrs of UC?
Colonoscopy
35
The following features are indicative of which IBD? - muscoal inflamm - affects colon- starts in rectum - continuous disease - inflammatory polyps
UC
36
Clinical presentation of UC? (4)
Diarrhoea -- urgency Rectal bleeding Anorexia --> weight loss Abdo pain
37
The complications of UC include...? CRC was already mentioned
Toxic megacolon Haemorrhage CRC
38
The complication of Crohns are the same as UC. What other ones are there that are not seen in UC?
Fistula Stricture Small bowel syndrome --> malabsorption
39
Crohns is transmural/affects any part of GI/ pathcy/ cobblestone appearence. T/F?
T
40
State 5 ways Crohns way present.
``` Bloody diarrhoea Colicky abdo pain Palpable abdo mass Mouth ulcers Anorexia ``` Peri-anal D Fever
41
Name systems in the body which may show extra IBD-mainfestations. (inflammatory)
``` Hepatic Renal Skeletal Haematological Mucocutaneous ```
42
Colorectal polyps are an outward mucosal protrusion. T/F?
F INWARD
43
What is the term for the common non-neoplastic polyps that are benign unless LARGE & RIGHT-SIDED?
Hyperplastic
44
Name the 2 non-neoplastic polyps that present in youth and ass with cancers
Juvenille polyps (malignanrt potential) Peutz-Jeghers syndrome (predisposes to many cancers)
45
The neoplastic benign polyp is called adenoma. Is it a precursor of CRC?
YES
46
What type of cancer is CRC generally?
Adenocarcinoma ~95%
47
Risk factors for CRC?
``` Diet Obesity IBD Alcohol NSAIDs HRT FH Adenoma pelvic radiation Schistosomiasis ```
48
Are most CRC related to FH or sporadic?
Sporadic ~ 75% | FH ~20%
49
Which inhertied conditions increase your risk of CRC? | Which one also increases risk for other cancers?
HNPCC* | FAP 100%
50
Where does CRC tend to spread to?
Liver | Lung
51
State the staging system for CRC.
``` Dukes A: confined to wall B: invading wall C: regional LN D: distant mets ```
52
What mode of infection is common in Infectious Gastroenteritis (GE)
Food/water-bourne
53
Common viral causes of GE include Rotavirus/Norovirus. What about bacteria?
``` Salmonella E.Coli Campylobactera V.cholerae C.dif ```
54
Presenting complaint of GE are SUDDEN non-specific GI symptoms. Complications?
``` Dehydration Renal dysfunction Toxic megacolon GBS HUS ```
55
What SHOULDN'T you give to treat GE?
ANTIBIOTICS (except in young/old/immunocomp) bacteria dying will release toxins --> worse
56
The Winter-vomiting disease = Norovirus. What is the classic presentation? Treatment?
Diarrhoea Projectile vomiting 24-48hr illness Supportive
57
Which strain of E.Coli releases shinga toxin causing diarrhoea + dehydration?
E.Coli 0157
58
Complication of E.Col 0157 GE?
HUS Shinga toxin acts on RBC
59
Antibiotic-associated diarrhoea can occur up to how long after treatment?
2 months
60
C.dif is common in >60s / taken borad spectrum antibiotics. Whats the treatment?
Oral Metronidazole/Vancomycin! Faecal transplants
61
State 2 sources of intra-abdominal infections.
GI tract | Blood
62
What are the 3 mechanisms of how an intra-abdo infection can occur?
1. Translocation across wall (Perforated Appendix/Diverticulum) 2. Translocation across lumen (hepatobiliary) 3. Translocation from extra-intestinal source (blood, trauma)
63
Cholecystitis = ? Causes?
= inflammation of GB wall Obstruction of cystic duct (GALL STONES, malignancy, worms, ERCP)
64
How does cholecystitis present?
RUQ pain Fever Mild jaundice
65
Complication and treatment of cholecystitis?
Empyema of GB Remove pus
66
Cholangitis = ? Causes? Presentation?
= Inflammation of biliary tree Same as cholecystitis
67
Intraperitoneal abscesses can be caused by...?
``` Perforation Cholecystitis/Cholangitis Ischaemia Pancreatitis Anastomatic leak ```
68
Is the presentation oof intra-peritoneal abscesses specific or non-specific?
Non-specific Sweating Anorexia High fever
69
State the locations where intra-peritoneal abscesses occur.
Subphrenic Subheaptic Paracolic Pelvic
70
How would you investigate intra-abdominal infections?
Bloods: FBC, CRP, LFTs Imaging: CXR, USS, Abdo CT Microbiological: microscopy, culture, sensitivity testing
71
Intra-abdominal infections are treated diff for > 65s and
Start: | Cefuroxime + Metronidazole 65s
72
What are the 3 phases post-trauma?
Phase 1: Clinical shock Phase 2: Catabolic state Phase 3: Anabolic state
73
What is the amrker for tissue hypoxia?
LACTATE
74
When is a patient most vulnerable of refeeding syndrome? What is it?
IN ANABOLIC PHASE If feed too quickly from malnourishment --> increased uptake into cells --> ions decrease in blood (when already low) --> CARDIAC ARREST
75
Manifestation of refeeding syndrome after tests?
Decreased K/Mg/Pi, Thiame Salt/H20 retetion --> oedema
76
The term for inflammation of the large intestine due to C.dif overgrowth? Complication of antibitoic therapy.
Pseudomembranous colitis
77
What is the term for inflammation of the ascites fluid?
Spontaneous Bacterial Peritonitis
78
~10 days post-trauma patients are at risk of what respiratory syndrome?
ARDS

Clinical Pathology (13 decks)

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